Provider Demographics
NPI:1982697314
Name:KIRSCH, KARL R (PT)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:R
Last Name:KIRSCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4661
Mailing Address - Country:US
Mailing Address - Phone:605-716-6474
Mailing Address - Fax:605-716-6484
Practice Address - Street 1:2001 7TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4661
Practice Address - Country:US
Practice Address - Phone:605-716-6474
Practice Address - Fax:605-716-6484
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5831482Medicaid
SD41219Medicare ID - Type Unspecified