Provider Demographics
NPI:1962771477
Name:KILGORE-VOHLKEN, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KILGORE-VOHLKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12276 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8628
Mailing Address - Country:US
Mailing Address - Phone:904-886-3228
Mailing Address - Fax:904-886-3297
Practice Address - Street 1:12276 SAN JOSE BLVD
Practice Address - Street 2:SUITE 508
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8628
Practice Address - Country:US
Practice Address - Phone:904-886-3228
Practice Address - Fax:904-886-3297
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-14-5808106E00000X
FLPT32623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst