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NPI Code Detail

MEDICARE: NICOLE E KITT

MEDICARE: NICOLE E KITT
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1477289379
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE E KITT
Provider Business Mailing Address
First Line : 1034 BRETON LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1207
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3731 W COOK RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-9662
Country : US
Telephone Number : 260-490-2112
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2022
Last Update Date : 07/25/2022

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Directions to “ NICOLE E KITT ” Practice Location

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