Provider Demographics
NPI:1760547939
Name:KILLIAN, RICKEY DON (PT)
Entity Type:Individual
Prefix:
First Name:RICKEY
Middle Name:DON
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 HOMER RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3024
Mailing Address - Country:US
Mailing Address - Phone:318-371-6666
Mailing Address - Fax:
Practice Address - Street 1:906 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3024
Practice Address - Country:US
Practice Address - Phone:318-371-6666
Practice Address - Fax:318-371-9966
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT306R261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1649276197OtherBUSINESS NPI