Provider Demographics
NPI:1124477088
Name:KIRBY, TERESA SUE (DPT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:SUE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6288 W 301ST ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66523-9064
Mailing Address - Country:US
Mailing Address - Phone:620-794-1611
Mailing Address - Fax:
Practice Address - Street 1:118 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LEBO
Practice Address - State:KS
Practice Address - Zip Code:66856-9437
Practice Address - Country:US
Practice Address - Phone:620-794-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist