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General NPI Number Information
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NPI Number | 1710597695
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Entity Type | Individual
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Provider Name | ALYSSA KIRK PT
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Gender | Female
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 2240 WINROW RD
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City | FORT HUACHUCA
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State | AZ
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Zip | 85613-5080
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Country | US
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Telephone | 520-533-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 81501 BISSEL ST
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City | SIERRA VISTA
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State | AZ
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Zip | 85613
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Country | US
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Telephone | 520-533-7655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0017913
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License Number State | CO
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