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General NPI Number Information
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NPI Number | 1437202793
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Entity Type | Organization
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Legal Business Name | KEMPSVILLE PHYSICAL THERAPY P C
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 5265 PROVIDENCE RD SUITE 503
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4206
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Country | US
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Telephone | 757-523-4705
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Fax | 757-523-4653
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Provider Business Mailing Address
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Address Line | 5265 PROVIDENCE RD SUITE 503
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4206
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Country | US
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Telephone | 757-961-7430
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Fax | 757-523-4653
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Authorized Official
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Title or Position | OWNER
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Name | MS. LINDA CAROL NIECE-BOAZ
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Credential | P.T.
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Telephone | 757-523-4705
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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 | 2305002340
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License Number State | VA
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