Provider Demographics
NPI:1144629593
Name:BIRNEY, KALEB SHANE (ATC, LAT, CSS)
Entity type:Individual
Prefix:MR
First Name:KALEB
Middle Name:SHANE
Last Name:BIRNEY
Suffix:
Gender:M
Credentials:ATC, LAT, CSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 AURORA LANE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-7354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 S ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3511
Practice Address - Country:US
Practice Address - Phone:406-683-7329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAT-LAT-LIC-1102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist