Healthcare Provider Details

I. General information

NPI: 1366477242
Provider Name (Legal Business Name): BRIAN KIRBY MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 HOLME AVE
PHILADELPHIA PA
19152-3009
US

IV. Provider business mailing address

22 AUSTIN RD
YARDLEY PA
19067-2802
US

V. Phone/Fax

Practice location:
  • Phone: 215-992-4977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberPT013564L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: