Healthcare Provider Details

I. General information

NPI: 1205371119
Provider Name (Legal Business Name): TIMOTHY KIRKHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2016
Last Update Date: 12/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LANTERN CREST WAY
SANTEE CA
92071-4646
US

IV. Provider business mailing address

PO BOX N
DEL MAR CA
92014-0376
US

V. Phone/Fax

Practice location:
  • Phone: 949-290-7144
  • Fax:
Mailing address:
  • Phone: 949-290-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: