Provider Demographics
NPI:1790801546
Name:KIRCHOFF, DORIE LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:DORIE
Middle Name:LYNN
Last Name:KIRCHOFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DORETTA
Other - Middle Name:LYNN
Other - Last Name:KIRCHOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:341 SE 1ST AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7101
Mailing Address - Country:US
Mailing Address - Phone:954-783-8157
Mailing Address - Fax:
Practice Address - Street 1:341 SE 1ST AVE APT 1
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7101
Practice Address - Country:US
Practice Address - Phone:954-783-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19150225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA 19150OtherSTATE LICENSE