Provider Demographics
NPI:1023737277
Name:KIRTLAND, LANILYN ELEANOR (DPT)
Entity type:Individual
Prefix:
First Name:LANILYN
Middle Name:ELEANOR
Last Name:KIRTLAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5016
Mailing Address - Country:US
Mailing Address - Phone:941-408-0670
Mailing Address - Fax:941-408-0160
Practice Address - Street 1:2990 US 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-2008
Practice Address - Country:US
Practice Address - Phone:941-721-1854
Practice Address - Fax:941-721-1859
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist