Provider Demographics
NPI:1942387329
Name:KIRK, MAXI LANG (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:MAXI
Middle Name:LANG
Last Name:KIRK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 COUNTY ROAD 336
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-3926
Mailing Address - Country:US
Mailing Address - Phone:325-670-6058
Mailing Address - Fax:325-670-6021
Practice Address - Street 1:518 COUNTY ROAD 336
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:TX
Practice Address - Zip Code:79562-3926
Practice Address - Country:US
Practice Address - Phone:325-670-6058
Practice Address - Fax:325-670-6021
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist