Provider Demographics
NPI:1497176960
Name:KILLINGSWORTH, KAYLENE
Entity Type:Individual
Prefix:
First Name:KAYLENE
Middle Name:
Last Name:KILLINGSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 S MAGNOLIA ST
Mailing Address - Street 2:STE 800
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-5672
Mailing Address - Country:US
Mailing Address - Phone:409-283-2554
Mailing Address - Fax:409-283-8446
Practice Address - Street 1:102 N BEECH ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4718
Practice Address - Country:US
Practice Address - Phone:409-283-2554
Practice Address - Fax:409-283-8446
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist