Provider Demographics
NPI:1700380763
Name:KILLEBREW, ROBERT W (DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:KILLEBREW
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7525 METROPOLITAN DR STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4404
Mailing Address - Country:US
Mailing Address - Phone:844-316-7979
Mailing Address - Fax:866-813-1235
Practice Address - Street 1:1828 OCEANSIDE BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3452
Practice Address - Country:US
Practice Address - Phone:844-316-7979
Practice Address - Fax:866-813-1235
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12776992081S0010X
CA301735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty