Healthcare Provider Details

I. General information

NPI: 1578757993
Provider Name (Legal Business Name): JENNIFER L KIRBY PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W PROSPECT ST
THORP WI
54771-9303
US

IV. Provider business mailing address

615 E POLK AVE
EAU CLAIRE WI
54701-3205
US

V. Phone/Fax

Practice location:
  • Phone: 156-695-3217
  • Fax:
Mailing address:
  • Phone: 602-206-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0730
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8050
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: