Active NPI
Kenneth W. Kirby Jr., DPT, CSCS
- Physical Therapist
- Wake Forest, NC
National Provider Identifier
1861415770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10662
- Practice address
- 847 Wake Forest Business Park
Suite 202
Wake Forest, NC 27587-6575 - Phone
- (919) 562-9410
- Fax
- (919) 542-2948
- NPI assigned
- Jul 25, 2006
- Last updated
- Jan 19, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10662 | NC | Primary |
Addresses
Primary practice location
847 Wake Forest Business Park
Suite 202
Wake Forest, NC 27587-6575
Mailing address
847 Wake Forest Business Park
Suite 202
Wake Forest, NC 27587-6575
Phone (919) 542-9410
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89013RF | Medicaid | NC | |
| 7280958 | Other | NC | AETNA |
| 068EP | Other | NC | BCBS |
| 199858 | Other | NC | MEDCOST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10662 | NC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopaedic Specialists of North Carolina, P.a. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba OrthoNC
- Orthopaedic Surgery Physician
- Raleigh, NC
- NPI 1649327750
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232323200000",
"number": "1861415770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "847 WAKE FOREST BUSINESS PARK",
"address_2": "SUITE 202",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275876575",
"telephone_number": "919-542-9410",
"fax_number": "919-542-2948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "847 WAKE FOREST BUSINESS PARK",
"address_2": "SUITE 202",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275876575",
"telephone_number": "919-562-9410",
"fax_number": "919-542-2948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRBY",
"first_name": "KENNETH",
"middle_name": "W.",
"name_suffix": "Jr.",
"credential": "DPT, CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2009-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "10662",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89013RF",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7280958",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "068EP",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "199858",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wake Forest, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.