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NPI Code Detail

MEDICARE: KIRBY WHITE PTA

MEDICARE: KIRBY WHITE PTA
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
1225200000XPhysical Therapy AssistantA3121MD

General Provider Information

NPI Number : 1912118258
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRBY WHITE PTA
Provider Business Mailing Address
First Line : 907 N KENWOOD AVE
Second Line :
City : BALTIMORE
State : MD
Zip : 21205-1307
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2601 GARRETT RD
Second Line :
City : WHITE HALL
State : MD
Zip : 21161-9743
Country : US
Telephone Number : 410-245-5030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 07/08/2007

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Directions to “ KIRBY WHITE PTA” Practice Location

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