Individual provider Active NPI

Brandi Dawn Kirk, PT

  • Physical Therapist
  • Homer Glen, IL
National Provider Identifier
1851334288
Registry record updated Dec 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-009741 Issued in IL
Practice address
14815 Founders Xing
Homer Glen, IL 60491-6705
Phone
(708) 301-3102
Fax
(708) 301-4450
NPI assigned
Jun 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070-009741 IL Primary

Addresses

Primary practice location

14815 Founders Xing
Homer Glen, IL 60491-6705

Mailing address

17W735 Kirkland LN
Villa Park, IL 60181-3751
Phone (630) 881-6332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-009741ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hand and Orthopaedic Surgery Center Inc Past Accepting new patients
Women'S Physical Therapy Institute Inc. Physical Therapist PastSince Apr 1, 2004 Accepting new patients
Poremba LTD Dba Rehab Connections PC PastSince Jul 1, 2000 Accepting new patients
Michael Reilly M.D. Holistic & Family Practice Medicine LTD Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291766400000",
    "number": "1851334288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17W735 KIRKLAND LN",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601813751",
            "telephone_number": "630-881-6332",
            "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": {
        "last_name": "KIRK",
        "first_name": "BRANDI",
        "middle_name": "DAWN",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2010-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-009741",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 8, 2010; 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.