Healthcare Provider Details

I. General information

NPI: 1295405710
Provider Name (Legal Business Name): ERIC KEMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 ROOSEVELT BLVD # B4
PHILADELPHIA PA
19114-2212
US

IV. Provider business mailing address

3450 BOWMAN ST
PHILADELPHIA PA
19129-1509
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-6200
  • Fax:
Mailing address:
  • Phone: 717-635-0995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: