Provider Demographics
NPI:1437245073
Name:KIRK, IAN RANDAL (PT)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:RANDAL
Last Name:KIRK
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 1:4874 BLAZER PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3302
Mailing Address - Country:US
Mailing Address - Phone:614-718-2673
Mailing Address - Fax:614-718-2033
Practice Address - Street 1:4874 BLAZER PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3302
Practice Address - Country:US
Practice Address - Phone:614-718-2673
Practice Address - Fax:614-718-2033
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT009446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist