Provider Demographics
NPI: | 1821038472 |
---|---|
Name: | KIRGAN, REBECCA (PT) |
Entity Type: | Individual |
Prefix: | |
First Name: | REBECCA |
Middle Name: | |
Last Name: | KIRGAN |
Suffix: | |
Gender: | F |
Credentials: | PT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 105 CRESTVIEW DR |
Mailing Address - Street 2: | |
Mailing Address - City: | SOUTH PORTLAND |
Mailing Address - State: | ME |
Mailing Address - Zip Code: | 04106-7800 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 207-797-3006 |
Mailing Address - Fax: | 207-797-3002 |
Practice Address - Street 1: | 74 GRAY RD |
Practice Address - Street 2: | |
Practice Address - City: | FALMOUTH |
Practice Address - State: | ME |
Practice Address - Zip Code: | 04105-2019 |
Practice Address - Country: | US |
Practice Address - Phone: | 207-797-3006 |
Practice Address - Fax: | 207-797-3002 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-08 |
Last Update Date: | 2007-07-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ME | PT2542 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
5632878 | Other | CCN INDIV. # | |
9992617 | Other | CIGNA INDIV # | |
ME | 048646 | Other | ANTHEM ME INDIV. # |
ME | 18874001 | Medicaid | |
7015693 | Other | AETNA PIN # | |
ME | 18874001 | Medicaid |