MEDICARE: KATHRYN SOULEN KIRSE

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	10010	NC

General Provider Information

NPI Number	:	1841435831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN SOULEN KIRSE

Provider Business Mailing Address
First Line	:	3369 SALLY KIRK RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-4776
Country	:	US
Telephone Number	:	336-765-1223
Fax Number	:

Provider Business Practice Location Address
First Line	:	3369 SALLY KIRK RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-4776
Country	:	US
Telephone Number	:	336-765-1223
Fax Number	:

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

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	12/05/2008

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Directions to “ KATHRYN SOULEN KIRSE ” Practice Location

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