Provider Demographics
NPI:1396964581
Name:CABANILLA, KIRK PATRIC (ATC)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:PATRIC
Last Name:CABANILLA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14857 PIERCE RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MI
Mailing Address - Zip Code:48418-8882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 BAY RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2438
Practice Address - Country:US
Practice Address - Phone:989-797-6040
Practice Address - Fax:989-797-6054
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer