MEDICARE: DEIDRE MARIE KIRKPATRICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT000696	PA

General Provider Information

NPI Number	:	1689784498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIDRE MARIE KIRKPATRICK

Provider Business Mailing Address
First Line	:	3010 WEST LAKE RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-3849
Country	:	US
Telephone Number	:	814-833-2022
Fax Number	:	814-838-1223

Provider Business Practice Location Address
First Line	:	3010 WEST LAKE RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-3849
Country	:	US
Telephone Number	:	814-833-2022
Fax Number	:	814-838-1223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ DEIDRE MARIE KIRKPATRICK ” Practice Location

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