Provider Demographics
NPI:1184071839
Name:MEMERY, KIRA (DPT)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:MEMERY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2585 WATKINS LN
Mailing Address - Street 2:
Mailing Address - City:GORDONSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22942-1815
Mailing Address - Country:US
Mailing Address - Phone:434-953-8567
Mailing Address - Fax:
Practice Address - Street 1:5928 SEMINOLE TRL
Practice Address - Street 2:SUITE 103
Practice Address - City:BARBOURSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22923-2872
Practice Address - Country:US
Practice Address - Phone:434-985-2198
Practice Address - Fax:434-985-3227
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305205475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09457Medicare PIN