Provider Demographics
NPI:1841435831
Name:KIRSE, KATHRYN SOULEN
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SOULEN
Last Name:KIRSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:KIRSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:3369 SALLY KIRK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4776
Mailing Address - Country:US
Mailing Address - Phone:336-765-1223
Mailing Address - Fax:
Practice Address - Street 1:3369 SALLY KIRK RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4776
Practice Address - Country:US
Practice Address - Phone:336-765-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist