Provider Demographics
NPI:1093339459
Name:PETRIE, KIRK (RRT)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:PETRIE
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:808 WIGGINGTON RD STE E
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5155
Mailing Address - Country:US
Mailing Address - Phone:434-385-4001
Mailing Address - Fax:434-385-1003
Practice Address - Street 1:808 WIGGINGTON RD STE E
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5155
Practice Address - Country:US
Practice Address - Phone:434-385-4001
Practice Address - Fax:434-385-1003
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0117003639227900000X, 2279H0200X, 2279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health