Provider Demographics
NPI:1538377593
Name:KIRK, VIRGINIA LEE (PTA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:KIRK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 US HIGHWAY 68 E
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-6527
Mailing Address - Country:US
Mailing Address - Phone:270-354-8523
Mailing Address - Fax:
Practice Address - Street 1:903 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2434
Practice Address - Country:US
Practice Address - Phone:270-767-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA00667225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant