Provider Demographics
NPI:1942807375
Name:KIRBY, HUGHSTON C (PT)
Entity Type:Individual
Prefix:
First Name:HUGHSTON
Middle Name:C
Last Name:KIRBY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1509
Mailing Address - Country:US
Mailing Address - Phone:540-239-0307
Mailing Address - Fax:
Practice Address - Street 1:111 CHURCH ST NW STE 201
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4536
Practice Address - Country:US
Practice Address - Phone:703-272-8340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213759225100000X
VA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist