Healthcare Provider Details

I. General information

NPI: 1275067001
Provider Name (Legal Business Name): KENT INTEGRATIVE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 ROYAL PALM ARCH
VIRGINIA BEACH VA
23452-3608
US

IV. Provider business mailing address

3616 ROYAL PALM ARCH
VIRGINIA BEACH VA
23452-3608
US

V. Phone/Fax

Practice location:
  • Phone: 804-922-6505
  • Fax:
Mailing address:
  • Phone: 757-447-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2305208118
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number2305208118
License Number StateVA

VIII. Authorized Official

Name: SHIRLEY KENT
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: DPT
Phone: 757-447-7278