Provider Demographics
NPI:1982824793
Name:KIRBY, JAMIE LYN (MSPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 GREEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-5548
Mailing Address - Country:US
Mailing Address - Phone:319-553-0083
Mailing Address - Fax:
Practice Address - Street 1:211 E RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5039
Practice Address - Country:US
Practice Address - Phone:319-272-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist