Provider Demographics
NPI:1083270532
Name:KIRBY, SUMMER J (LMP)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:J
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 SUMMITVIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3018
Mailing Address - Country:US
Mailing Address - Phone:509-895-7383
Mailing Address - Fax:509-469-1905
Practice Address - Street 1:5603 SUMMITVIEW AVE STE 100
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3018
Practice Address - Country:US
Practice Address - Phone:509-895-7383
Practice Address - Fax:509-469-1905
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA6098290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA6098290OtherPROFESSIONAL LICENSE