Provider Demographics
NPI:1942464870
Name:KIRKBY, THOMAS WILLIAM (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:KIRKBY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 S US HIGHWAY 131
Mailing Address - Street 2:PO BOX 501
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8336
Mailing Address - Country:US
Mailing Address - Phone:989-854-0154
Mailing Address - Fax:231-439-5918
Practice Address - Street 1:1691 S US HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8336
Practice Address - Country:US
Practice Address - Phone:989-854-0154
Practice Address - Fax:231-439-5918
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2018-03-27
Deactivation Date:2018-02-27
Deactivation Code:
Reactivation Date:2018-03-27
Provider Licenses
StateLicense IDTaxonomies
MI5501013904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist