Provider Demographics
NPI:1689021073
Name:KIRBY, BRENDAN
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:KIRBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E LANCASTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2321
Mailing Address - Country:US
Mailing Address - Phone:610-642-4494
Mailing Address - Fax:610-642-7017
Practice Address - Street 1:233 E LANCASTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2321
Practice Address - Country:US
Practice Address - Phone:610-642-4494
Practice Address - Fax:610-642-7017
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist