Provider Demographics
NPI:1740013200
Name:HARGUS, KAITLYN WRAY (DPT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:WRAY
Last Name:HARGUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WHITE OAK ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9590
Mailing Address - Country:US
Mailing Address - Phone:828-551-6964
Mailing Address - Fax:
Practice Address - Street 1:1064 W MILLS ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-8401
Practice Address - Country:US
Practice Address - Phone:828-894-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist