Provider Demographics
NPI:1528247079
Name:CONROW, KIRK (PT)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:CONROW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5658
Mailing Address - Country:US
Mailing Address - Phone:772-664-6170
Mailing Address - Fax:772-664-6180
Practice Address - Street 1:1001 NORTH ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-5658
Practice Address - Country:US
Practice Address - Phone:772-664-6170
Practice Address - Fax:772-664-6180
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist