Provider Demographics
NPI:1124066287
Name:KILLIAN, KYLA SUE (PT)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:SUE
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 GREENVILLE AVE
Mailing Address - Street 2:SUITE 425
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3832
Mailing Address - Country:US
Mailing Address - Phone:214-369-7881
Mailing Address - Fax:214-369-7882
Practice Address - Street 1:7502 GREENVILLE AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-369-7881
Practice Address - Fax:214-369-7882
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1106250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist