MEDICARE: JILL M KIRBY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05009372A	IN

General Provider Information

NPI Number	:	1740399740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL M KIRBY PT, DPT

Provider Business Mailing Address
First Line	:	4242 SAFFRON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-3609
Country	:	US
Telephone Number	:	317-885-8342
Fax Number	:	317-885-8342

Provider Business Practice Location Address
First Line	:	4242 SAFFRON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-3609
Country	:	US
Telephone Number	:	317-885-8342
Fax Number	:	317-885-8342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/18/2009

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