Healthcare Provider Details

I. General information

NPI: 1245431469
Provider Name (Legal Business Name): KIMBERLI ANN KIRKLAND PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 MIDWESTERN PKWY
WICHITA FALLS TX
76302-2211
US

IV. Provider business mailing address

1005 MIDWESTERN PKWY
WICHITA FALLS TX
76302-2211
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-0771
  • Fax: 940-767-3715
Mailing address:
  • Phone: 940-322-0771
  • Fax: 940-767-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4041730
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: