Provider Demographics
NPI:1578828182
Name:CANADA, KIRK A (PT , DPT)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:A
Last Name:CANADA
Suffix:
Gender:M
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 1:1717 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3043
Mailing Address - Country:US
Mailing Address - Phone:325-676-5633
Mailing Address - Fax:325-676-8831
Practice Address - Street 1:1717 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3043
Practice Address - Country:US
Practice Address - Phone:325-676-5633
Practice Address - Fax:325-676-8831
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3111840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist