MEDICARE: JEFFREY ALAN KEMP MS, PT

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	225100000X	Physical Therapist	02099	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	421493296-01	OTHER	IA	JOHN DEERE PROVIDER ID
3	45190	OTHER	IA	BLUE CROSS BLUE SHIELD ID

General Provider Information

NPI Number	:	1881693372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ALAN KEMP MS, PT

Provider Business Mailing Address
First Line	:	315 E SAN MARNAN DR
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5837
Country	:	US
Telephone Number	:	319-239-5009
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 E SAN MARNAN DR
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5837
Country	:	US
Telephone Number	:	319-239-5009
Fax Number	:

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	03/23/2012

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