Provider Demographics
NPI:1922144997
Name:KILLEEN, RICHARD SCOTT (PT GCFP CSI)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SCOTT
Last Name:KILLEEN
Suffix:
Gender:M
Credentials:PT GCFP CSI
Other - Prefix:
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Mailing Address - Street 1:500 EAST MAIN STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-315-7727
Mailing Address - Fax:203-315-7757
Practice Address - Street 1:500 EAST MAIN STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405
Practice Address - Country:US
Practice Address - Phone:203-315-7727
Practice Address - Fax:203-315-7757
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist