Provider Demographics
NPI:1871251116
Name:KILLINGBECK, KAMILLE NIKOLE (PT, DPT, PTRP)
Entity type:Individual
Prefix:
First Name:KAMILLE
Middle Name:NIKOLE
Last Name:KILLINGBECK
Suffix:
Gender:F
Credentials:PT, DPT, PTRP
Other - Prefix:
Other - First Name:KAMILLE NIKOLE
Other - Middle Name:HUEYSUWAN
Other - Last Name:FLORIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, PTRP
Mailing Address - Street 1:8020 W SAHARA AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8020 W SAHARA AVE STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7917
Practice Address - Country:US
Practice Address - Phone:702-595-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4876225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist