MEDICARE: KIRBY L COLUMBER PT, DPT, OCS

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	PT 014224	OH

General Provider Information

NPI Number	:	1992142665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRBY L COLUMBER PT, DPT, OCS

Provider Business Mailing Address
First Line	:	120 COLEMANS XING
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-7115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 COLEMANS XING
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-7115
Country	:	US
Telephone Number	:	937-578-7841
Fax Number	:	937-578-7891

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

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	11/28/2018

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