MEDICARE: KIMBERLY AKIYE MICHIKO ITO 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
1	225100000X	Physical Therapist	P-CP032402T	NC
2	225100000X	Physical Therapist	PT021240	OH

General Provider Information

NPI Number	:	1558108175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY AKIYE MICHIKO ITO DPT

Provider Business Mailing Address
First Line	:	805 SOUTHVIEW CIR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-0359
Country	:	US
Telephone Number	:	330-554-8041
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 FRANCAM DR # 124
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-4500
Country	:	US
Telephone Number	:	910-229-3924
Fax Number	:

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	09/04/2024

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