Provider Demographics
NPI:1467525857
Name:KIRKLAND, CHARLES A (PT, DPT, DMT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:KIRKLAND
Suffix:
Gender:
Credentials:PT, DPT, DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8460 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-2247
Mailing Address - Country:US
Mailing Address - Phone:248-210-8805
Mailing Address - Fax:219-285-5689
Practice Address - Street 1:1600 RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202
Practice Address - Country:US
Practice Address - Phone:501-663-6965
Practice Address - Fax:501-603-0675
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010477A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic