Provider Demographics
NPI:1255489381
Name:KIRBY, JUNE R (LMT)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:R
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 SORRENTO INLT
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-1410
Mailing Address - Country:US
Mailing Address - Phone:941-966-1027
Mailing Address - Fax:941-966-1027
Practice Address - Street 1:724 SORRENTO INLT
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-1410
Practice Address - Country:US
Practice Address - Phone:941-966-1027
Practice Address - Fax:941-966-1027
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14842225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist