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NPI Code Detail

MEDICARE: DR. KYLAH MOSHAE GEORGE PT, DPT

MEDICARE: DR. KYLAH MOSHAE GEORGE PT, 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 TherapistCP041063TOH
2225100000XPhysical Therapist12824SC
3225100000XPhysical TherapistP22054NC

General Provider Information

NPI Number : 1306682596
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYLAH MOSHAE GEORGE PT, DPT
Provider Business Mailing Address
First Line : 8918 BLAKENEY PROFESSIONAL DR STE 120
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-6692
Country : US
Telephone Number : 704-900-8960
Fax Number :
Provider Business Practice Location Address
First Line : 857 PROMENADE WALK
Second Line :
City : FORT MILL
State : SC
Zip : 29708-6992
Country : US
Telephone Number : 803-547-1133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2024
Last Update Date : 05/23/2025

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