1437202793 NPI number — KEMPSVILLE PHYSICAL THERAPY P C

Table of content: (NPI 1437202793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437202793 NPI number — KEMPSVILLE PHYSICAL THERAPY P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEMPSVILLE PHYSICAL THERAPY P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KEMPSVILLE PHYSICAL THEGRP
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437202793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5265 PROVIDENCE RD
Provider Second Line Business Mailing Address:
SUITE 503
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23464-4206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-961-7430
Provider Business Mailing Address Fax Number:
757-523-4653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5265 PROVIDENCE RD
Provider Second Line Business Practice Location Address:
SUITE 503
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23464-4206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-523-4705
Provider Business Practice Location Address Fax Number:
757-523-4653
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NIECE-BOAZ
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
CAROL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-523-4705

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305002340 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 239374 . This is a "BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com