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NPI Code Detail

MEDICARE: HADEN KNIGHT THOMAS DPT

MEDICARE: HADEN KNIGHT THOMAS DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist
2225100000XPhysical TherapistP17080NC

General Provider Information

NPI Number : 1790295384
Entity Type Code : Individual
Provider Name (Legal Business Name) : HADEN KNIGHT THOMAS DPT
Provider Business Mailing Address
First Line : 8622 TAMARRON DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-1871
Country : US
Telephone Number : 630-715-9931
Fax Number :
Provider Business Practice Location Address
First Line : 5800 OLD PROVIDENCE RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-6872
Country : US
Telephone Number : 704-869-2248
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2017
Last Update Date : 09/04/2020

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