Provider Demographics
NPI:1982277042
Name:GOAD, KIRBY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:
Last Name:GOAD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 FIRST COAST HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-5598
Mailing Address - Country:US
Mailing Address - Phone:904-321-5491
Mailing Address - Fax:904-321-5478
Practice Address - Street 1:4800 FIRST COAST HWY STE 240
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-5598
Practice Address - Country:US
Practice Address - Phone:904-321-5491
Practice Address - Fax:904-321-5478
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT258862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic