Provider Demographics
NPI:1811013923
Name:KILLEBREW, MICHELLE T (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:KILLEBREW
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 1:800 CRESCENT CENTRE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7269
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY
Practice Address - Street 2:SUITE 2002
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2073
Practice Address - Country:US
Practice Address - Phone:769-300-1101
Practice Address - Fax:769-300-1102
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist