Provider Demographics
NPI:1518325554
Name:KIRBY, HEATHER REICHEL (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:REICHEL
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CAMINITO AMAPOLA
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3151
Mailing Address - Country:US
Mailing Address - Phone:760-695-8332
Mailing Address - Fax:
Practice Address - Street 1:131 CAMINITO AMAPOLA
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3151
Practice Address - Country:US
Practice Address - Phone:760-695-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist