Provider Demographics
NPI:1205124609
Name:KIRK, MARIAN E (PT)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:E
Last Name:KIRK
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 1:51 MONROE STREET
Mailing Address - Street 2:SUITE 1207
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-838-2040
Mailing Address - Fax:301-838-2041
Practice Address - Street 1:2960 TECHNOLOGY PLACE
Practice Address - Street 2:SUITE 110
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601
Practice Address - Country:US
Practice Address - Phone:301-893-2366
Practice Address - Fax:301-893-0609
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist