Provider Demographics
NPI:1578837407
Name:KIRBY, AARON KEITH (LMP, MMLT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:KEITH
Last Name:KIRBY
Suffix:
Gender:M
Credentials:LMP, MMLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5246 OLYMPIC DR NW
Mailing Address - Street 2:SUITE 118
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1723
Mailing Address - Country:US
Mailing Address - Phone:253-279-7495
Mailing Address - Fax:
Practice Address - Street 1:5246 OLYMPIC DR NW
Practice Address - Street 2:SUITE 118
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1723
Practice Address - Country:US
Practice Address - Phone:253-279-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024831225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist