Healthcare Provider Details

I. General information

NPI: 1891360921
Provider Name (Legal Business Name): KAYLA JORDAN DUPREE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12610 PATRICK HENRY DR STE H
NEWPORT NEWS VA
23602-9538
US

IV. Provider business mailing address

PO BOX 412307
BOSTON MA
02241-2307
US

V. Phone/Fax

Practice location:
  • Phone: 757-847-1470
  • Fax: 757-874-1472
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214341
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: