Provider Demographics
NPI:1396877676
Name:KILBURN, KAJA MARIE (PT, DPT, SCS, ATC)
Entity type:Individual
Prefix:
First Name:KAJA
Middle Name:MARIE
Last Name:KILBURN
Suffix:
Gender:F
Credentials:PT, DPT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E CAMELBACK RD
Mailing Address - Street 2:APT #3121
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3687
Mailing Address - Country:US
Mailing Address - Phone:802-236-7440
Mailing Address - Fax:
Practice Address - Street 1:4455 E CAMELBACK RD
Practice Address - Street 2:SUITE D-155
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2843
Practice Address - Country:US
Practice Address - Phone:602-808-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870765225100000X
AZ8307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist