1871251116 NPI number — KAMILLE NIKOLE KILLINGBECK PT, DPT, PTRP

Table of content: KAMILLE NIKOLE KILLINGBECK PT, DPT, PTRP (NPI 1871251116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871251116 NPI number — KAMILLE NIKOLE KILLINGBECK PT, DPT, PTRP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILLINGBECK
Provider First Name:
KAMILLE
Provider Middle Name:
NIKOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, PTRP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLORIDO
Provider Other First Name:
KAMILLE NIKOLE
Provider Other Middle Name:
HUEYSUWAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, PTRP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871251116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8020 W SAHARA AVE STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-7917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8020 W SAHARA AVE STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89117-7917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-595-5437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4876 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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