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General NPI Number Information
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NPI Number | 1578757993
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Entity Type | Individual
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Provider Name | JENNIFER L KIRBY PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 206 W PROSPECT ST
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City | THORP
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State | WI
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Zip | 54771-9303
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Country | US
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Telephone | 156-695-3217
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Fax |
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Provider Business Mailing Address
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Address Line | 615 E POLK AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54701-3205
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Country | US
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Telephone | 602-206-4739
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0730
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8050
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License Number State | AZ
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