Provider Demographics
NPI:1831242247
Name:MYLES, KJIRSTI ANN (PT)
Entity type:Individual
Prefix:
First Name:KJIRSTI
Middle Name:ANN
Last Name:MYLES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KJIRSTI
Other - Middle Name:ANN
Other - Last Name:MISSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:134 LODEN DR
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-9295
Mailing Address - Country:US
Mailing Address - Phone:910-603-7351
Mailing Address - Fax:910-483-8335
Practice Address - Street 1:1289 OLIVER ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4450
Practice Address - Country:US
Practice Address - Phone:910-483-8331
Practice Address - Fax:910-483-8335
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211888Medicaid