Provider Demographics
NPI:1578041133
Name:CARR, KIRA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 SHOAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5949
Mailing Address - Country:US
Mailing Address - Phone:608-213-7259
Mailing Address - Fax:
Practice Address - Street 1:1110 SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3529
Practice Address - Country:US
Practice Address - Phone:608-213-7259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14379-24225100000X
FL36304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist