Provider Demographics
NPI:1467602250
Name:KIRKPATRICK, DARLENE (PTA)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:8455 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5066
Mailing Address - Country:US
Mailing Address - Phone:352-567-5910
Mailing Address - Fax:352-567-6860
Practice Address - Street 1:14235 EDWINOLA WAY
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-3763
Practice Address - Country:US
Practice Address - Phone:352-567-5910
Practice Address - Fax:352-567-6860
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21234225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106898OtherMEDICARE ID