Provider Demographics
NPI:1629150644
Name:KILLIAN, VERA R (PT)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:R
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VERA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:262 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:CT
Mailing Address - Zip Code:06232-1709
Mailing Address - Country:US
Mailing Address - Phone:860-742-1859
Mailing Address - Fax:860-456-4941
Practice Address - Street 1:10 HIGGINS HWY
Practice Address - Street 2:SUITE 12
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061503332OtherAETNA
CT061503332002OtherTRICARE
CTA2752221OtherOXFORD
CT0014105OtherORTHONET HEALTHNET
CT14105OtherORTHONET CIGNA
CTOV7726OtherHEALTHNET