Provider Demographics
NPI:1730950783
Name:KIRBY, RATIA (LMT, MMT, NDTR)
Entity type:Individual
Prefix:
First Name:RATIA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LMT, MMT, NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MOUNTAIN AVE SW APT 1
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-3948
Mailing Address - Country:US
Mailing Address - Phone:434-222-4522
Mailing Address - Fax:
Practice Address - Street 1:402 MOUNTAIN AVE SW APT 1
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3948
Practice Address - Country:US
Practice Address - Phone:434-222-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86083840136A00000X
VA0019017997225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered