Provider Demographics
NPI:1134386261
Name:KIRBY, JULIE M (MPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:MARTINELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11871 GRANITE WOODS LOOP
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4134
Mailing Address - Country:US
Mailing Address - Phone:941-412-4465
Mailing Address - Fax:
Practice Address - Street 1:11871 GRANITE WOODS LOOP
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4134
Practice Address - Country:US
Practice Address - Phone:941-412-4465
Practice Address - Fax:941-412-4467
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106980Medicare Oscar/Certification