NPIMap

Organization Active NPI

Kirk Center for Healthy Living, PC

  • Physical Therapy Clinic/Center
  • Homer Glen, IL
National Provider Identifier
1124065743
Registry record updated Dec 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
KIRK CENTER FOR HEALTHY LIVING, PC
Practice address
14815 Founders Xing
Homer Glen, IL 60491-6705
Phone
(708) 301-3102
Fax
(708) 301-4450
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brandi Dawn Kirk, PT
Title
Physical Therapist President
Phone
(708) 301-3102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

14815 Founders Xing
Homer Glen, IL 60491-6705

Mailing address

14815 Founders Xing
Homer Glen, IL 60491-6705
Phone (708) 301-3102

Other identifiers 1

IdentifierTypeStateIssuer
09932478OtherILBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

14815 Founders Xing
Homer Glen, IL 60491
Phone (708) 301-3102

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196985600000",
    "number": "1124065743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14815 FOUNDERS XING",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604916705",
            "telephone_number": "708-301-3102",
            "fax_number": "708-301-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14815 FOUNDERS XING",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604916705",
            "telephone_number": "708-301-3102",
            "fax_number": "708-301-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRK CENTER FOR HEALTHY LIVING, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2007-12-07",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST PRESIDENT",
        "authorized_official_telephone_number": "708-301-3102",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "09932478",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Homer Glen, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.