Provider Demographics
NPI:1316413776
Name:KILLIANS THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:KILLIANS THERAPEUTIC SERVICES LLC
Other - Org Name:PELLETIER & KILLIAN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-456-3772
Mailing Address - Street 1:10 HIGGINS HWY STE 12
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1437
Mailing Address - Country:US
Mailing Address - Phone:860-456-3772
Mailing Address - Fax:860-456-4941
Practice Address - Street 1:10 HIGGINS HWY STE 12
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-456-3772
Practice Address - Fax:860-456-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006689OtherSTATE LICENSE NUMBER