Provider Demographics
NPI:1700644978
Name:KIRKENDOLL, MARISSA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:KIRKENDOLL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WESTMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2113
Mailing Address - Country:US
Mailing Address - Phone:609-721-1911
Mailing Address - Fax:
Practice Address - Street 1:440 N CAMINO MERCADO STE 8
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5750
Practice Address - Country:US
Practice Address - Phone:520-836-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02222000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist