Provider Demographics
NPI:1730226747
Name:KILLIAN, MATTHEW THOMAS
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STEPHANIE ST STE 310
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6608
Mailing Address - Country:US
Mailing Address - Phone:702-454-1162
Mailing Address - Fax:702-454-8817
Practice Address - Street 1:400 N STEPHANIE ST STE 310
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6608
Practice Address - Country:US
Practice Address - Phone:702-454-1162
Practice Address - Fax:702-454-8817
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16888225100000X
FLPT 16888225100000X
NV2398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702161Medicaid
NVDU0139OtherRAILROAD MEDICARE
NV1702161Medicaid
NVGG318AMedicare PIN
NVCCN264507Medicare PIN