Provider Demographics
NPI:1871840736
Name:KILBREATH, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KILBREATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 SUPERIOR WAY
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-4744
Mailing Address - Country:US
Mailing Address - Phone:804-561-1585
Mailing Address - Fax:804-561-7430
Practice Address - Street 1:2027 LAUDERDALE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-3940
Practice Address - Country:US
Practice Address - Phone:804-421-5250
Practice Address - Fax:804-421-5251
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist