Provider Demographics
NPI:1871840736
Name:KILBREATH, JAMES SMITH II (DPT)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SMITH
Last Name:KILBREATH
Suffix:II
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JIMMY
Other - Middle Name:
Other - Last Name:KILBREATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:10130 SUPERIOR WAY
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-4744
Mailing Address - Country:US
Mailing Address - Phone:804-561-1585
Mailing Address - Fax:804-561-7430
Practice Address - Street 1:10130 SUPERIOR WAY
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4744
Practice Address - Country:US
Practice Address - Phone:804-561-1585
Practice Address - Fax:804-561-7430
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist