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NPI Code Detail

MEDICARE: KITARSHYI MULDROW JACKSON PT

MEDICARE: KITARSHYI MULDROW JACKSON PT
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 Therapist7927NC
2225100000XPhysical Therapist20501CA

General Provider Information

NPI Number : 1306000864
Entity Type Code : Individual
Provider Name (Legal Business Name) : KITARSHYI MULDROW JACKSON PT
Provider Business Mailing Address
First Line : 125 LONG PINE RD
Second Line :
City : SOUTH MILLS
State : NC
Zip : 27976-9611
Country : US
Telephone Number : 252-771-8305
Fax Number :
Provider Business Practice Location Address
First Line : 1075 US HIGHWAY 17 S
Second Line :
City : ELIZABETH CITY
State : NC
Zip : 27909-7628
Country : US
Telephone Number : 252-338-3975
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2008
Last Update Date : 07/14/2008

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