Healthcare Provider Details

I. General information

NPI: 1083836316
Provider Name (Legal Business Name): MYLENE A KEMPERS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8965 GUILFORD RD STE 160
COLUMBIA MD
21046-2396
US

IV. Provider business mailing address

2001 WARNERS TER N UNIT 312
ANNAPOLIS MD
21401-8775
US

V. Phone/Fax

Practice location:
  • Phone: 410-796-8499
  • Fax: 443-270-8260
Mailing address:
  • Phone: 410-224-7237
  • Fax: 410-224-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number18323
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: