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General NPI Number Information
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NPI Number | 1316630189
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Entity Type | Individual
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Provider Name | KATHRYN PROFFITT KEPHART PT
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Gender | Female
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1628 LASKIN RD STE 706
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-7504
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Country | US
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Telephone | 757-481-0052
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 412307
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City | BOSTON
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State | MA
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Zip | 02241-2307
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Country | US
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Telephone | 914-294-4050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305215700
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License Number State | VA
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