Provider Demographics
NPI:1518975978
Name:KIRBY, CINDY L (PT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 PACHECO ST
Mailing Address - Street 2:SUITE A203
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5104
Mailing Address - Country:US
Mailing Address - Phone:505-473-2896
Mailing Address - Fax:505-992-2788
Practice Address - Street 1:1512 PACHECO ST
Practice Address - Street 2:SUITE A203
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5104
Practice Address - Country:US
Practice Address - Phone:505-473-2896
Practice Address - Fax:505-992-2788
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00Q655OtherBCBS OF NM
NMNM00Q655OtherBCBS OF NM