MEDICARE: MRS. JOYCE ZAINE KIGHT LPT

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	2251X0800X	Orthopedic Physical Therapist	2251	NC
2	2251X0800X	Orthopedic Physical Therapist	2129	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0786P	OTHER	NC	BLUE CROSS

General Provider Information

NPI Number	:	1629013909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOYCE ZAINE KIGHT LPT

Provider Business Mailing Address
First Line	:	PO BOX 472956
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28247-2956
Country	:	US
Telephone Number	:	704-541-1191
Fax Number	:	704-541-1192

Provider Business Practice Location Address
First Line	:	8025 CORPORATE CENTER DR
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4499
Country	:	US
Telephone Number	:	704-541-1191
Fax Number	:	704-541-1192

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	01/03/2008

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