Doctor Name: | ROGER ALAN KILCREASE |
NPI Number: | 1104014125 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | 5456 |
Business Practice Address: | 2191 Northlake Pkwy Suite 31 Tucker, GA - 300844166 |
Business Phone Number: | 7704916004 |
Business Fax Number: | 7707230872 |
Mailing Address: | 2191 Northlake Pkwy, Suite 31 TUCKER |
State: | GA |
Postal Code: | 300844166 |
Phone Number: | 7704916004 |
Fax Number: | 7707230872 |
NPI Enumeration Date: | 10/04/2007 |
NPI Last Update Date: | 10/04/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 5456 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |