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General NPI Number Information
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NPI Number | 1861544967
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Entity Type | Individual
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Provider Name | DANIEL CHESLEY KIRK PT
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 600 N HIGHLAND SPRINGS AVE
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City | BANNING
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State | CA
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Zip | 92220-3046
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Country | US
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Telephone | 951-769-2135
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Fax | 951-769-2136
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Provider Business Mailing Address
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Address Line | 22597 WESTLAKE DR
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City | MORENO VALLEY
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State | CA
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Zip | 92553-6439
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Country | US
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Telephone | 951-656-9172
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT23836
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT23836
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License Number State | CA
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