Healthcare Provider Details

I. General information

NPI: 1457276586
Provider Name (Legal Business Name): FAMOUS KIRK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 LAPALCO BLVD STE A
HARVEY LA
70058-2312
US

IV. Provider business mailing address

3436 LOUISE ST
HARVEY LA
70058-5458
US

V. Phone/Fax

Practice location:
  • Phone: 504-577-2844
  • Fax:
Mailing address:
  • Phone: 504-577-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12504
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: