Healthcare Provider Details

I. General information

NPI: 1790801546
Provider Name (Legal Business Name): DORIE LYNN KIRCHOFF P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORETTA LYNN KIRCHOFF

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 SE 1ST AVE APT 1
POMPANO BEACH FL
33060-7101
US

IV. Provider business mailing address

341 SE 1ST AVE APT 1
POMPANO BEACH FL
33060-7101
US

V. Phone/Fax

Practice location:
  • Phone: 954-783-8157
  • Fax:
Mailing address:
  • Phone: 954-783-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA19150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: