Provider Demographics
NPI:1407477391
Name:KILPATRICK, KAMERON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAMERON
Middle Name:
Last Name:KILPATRICK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 N GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6714
Mailing Address - Country:US
Mailing Address - Phone:972-809-6136
Mailing Address - Fax:
Practice Address - Street 1:3403 N GARDEN AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6714
Practice Address - Country:US
Practice Address - Phone:972-809-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist