Provider Demographics
NPI:1942260989
Name:MOORE, KIRBY L (BS, AT,C)
Entity Type:Individual
Prefix:MR
First Name:KIRBY
Middle Name:L
Last Name:MOORE
Suffix:
Gender:M
Credentials:BS, AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41197 S DUDLEY RD W
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-9259
Mailing Address - Country:US
Mailing Address - Phone:740-783-2034
Mailing Address - Fax:
Practice Address - Street 1:160 GROSS ST
Practice Address - Street 2:FRONTIER SHOPPING PLAZA
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2031
Practice Address - Country:US
Practice Address - Phone:740-374-3200
Practice Address - Fax:740-374-9560
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-0001092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer