Healthcare Provider Details

I. General information

NPI: 1205058005
Provider Name (Legal Business Name): JENNIFER KEMP PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17507 LEE HWY
ABINGDON VA
24210-7835
US

IV. Provider business mailing address

3010 PENN FOREST BLVD
ROANOKE VA
24018-4307
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-6043
  • Fax:
Mailing address:
  • Phone: 207-443-2319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305203509
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: