Healthcare Provider Details

I. General information

NPI: 1417073859
Provider Name (Legal Business Name): COLLEEN LOUISE VANKIRK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 LEE RD
FOLLANSBEE WV
26037-1783
US

IV. Provider business mailing address

234 LACY DR
STEUBENVILLE OH
43952-7909
US

V. Phone/Fax

Practice location:
  • Phone: 304-527-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001209
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA. 02006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: