Richard J Mckibben
Physical Therapist Electrophysiology, Clinical
100 A Lindsey Lane
Kingsland
, Georgia 31548-0000
Richard J Mckibben
Physical Therapist Electrophysiology, Clinical
100 A Lindsey Lane
Kingsland
, Georgia 31548-0000
(706) 802-1408
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About
Features
Specialties
- Physical Therapist
- Electrophysiology, Clinical
Languages spoken
- English
Location
First Address
- Richard J Mckibben
- Po Box 949
- Rome, GA
- Zip : 30162-0949
- Fax : (706) 802-1408
- Phone : (706) 236-2774
Second Address
- Richard J Mckibben
- 100 A Lindsey Lane
- Kingsland, GA
- Zip : 31548-0000
- Fax : (912) 729-5259
- Phone : (912) 729-1333
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225100000X | Physical Therapist | PT004832 | GA |
| N | 2251E1300X | Electrophysiology, Clinical | PT004832 | GA |
National Provider Identifier
| NPI | 1407949134 |
|---|---|
| Provider Name | Richard J Mckibben |
| First Address | Rome, GA 30162-0949 |
| Second Address | Kingsland, GA 31548-0000 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/10/2006 |
| Last Update Date | 10/11/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 818354932J | (05) | GA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.