Provider Demographics
NPI:1720058969
Name:KILLEA, PATRICIA JEAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEAN
Last Name:KILLEA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 34TH ROAD NORTH
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207
Mailing Address - Country:US
Mailing Address - Phone:973-945-8009
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL SERVICE CORPS STAFF
Practice Address - Street 2:NAVY MEDICINE SUPPORT BLDG 2005
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:904-542-7200
Practice Address - Fax:904-542-7286
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-01-09
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-01-09
Provider Licenses
StateLicense IDTaxonomies
CAPT 13672225100000X
NJ40QA01136300225100000X
CAEN 312251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical