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
StateLicense IDTaxonomies
MEPT2542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5632878OtherCCN INDIV. #
9992617OtherCIGNA INDIV #
ME048646OtherANTHEM ME INDIV. #
ME18874001Medicaid
7015693OtherAETNA PIN #
ME18874001Medicaid