1902060890 NPI number — MISS KIMBERLY SUZANNE BRUNT LPTA

Table of content: JOHNNIE WALKER-STAGGS LPC (NPI 1407931124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902060890 NPI number — MISS KIMBERLY SUZANNE BRUNT LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNT
Provider First Name:
KIMBERLY
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1902060890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 ABERTHAW AVE
Provider Second Line Business Mailing Address:
VIRGINIA HEALTH REHABILITATION AGENCY LLC
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-595-1946
Provider Business Mailing Address Fax Number:
757-595-3238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 ATLANTIC SHORES DRIVE
Provider Second Line Business Practice Location Address:
SEASIDE HEALTHCARE CENTER AT ATLANTIC SHORES
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-716-2150
Provider Business Practice Location Address Fax Number:
757-716-2027
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  2306000395 , 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)





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