MEDICARE: KIRA MARLOW

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
1	225100000X	Physical Therapist	P23517	NC

General Provider Information

NPI Number	:	1306678586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRA MARLOW

Provider Business Mailing Address
First Line	:	3431 RICHLANDS HWY STE 4
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-3003
Country	:	US
Telephone Number	:	910-803-3193
Fax Number	:

Provider Business Practice Location Address
First Line	:	3431 RICHLANDS HWY STE 4
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-3003
Country	:	US
Telephone Number	:	910-803-3193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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Directions to “ KIRA MARLOW ” Practice Location

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