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General NPI Number Information
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NPI Number | 1407949134
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Entity Type | Individual
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Provider Name | RICHARD J MCKIBBEN PT, DWC, ECS
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 100 A LINDSEY LANE
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City | KINGSLAND
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State | GA
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Zip | 31548-0000
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Country | US
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Telephone | 912-729-1333
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Fax | 912-729-5259
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Provider Business Mailing Address
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Address Line | PO BOX 949
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City | ROME
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State | GA
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Zip | 30162-0949
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Country | US
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Telephone | 706-236-2774
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Fax | 706-802-1408
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT004832
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number | PT004832
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License Number State | GA
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