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General NPI Number Information
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NPI Number | 1740419969
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Entity Type | Individual
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Provider Name | KELSEY LYNN HEARN PT
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Gender | Female
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 2135 GENERAL BOOTH BLVD SUITE 152
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5881
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Country | US
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Telephone | 757-430-8828
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Fax | 757-430-8189
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Provider Business Mailing Address
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Address Line | 2135 GENERAL BOOTH BLVD SUITE 152
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5881
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Country | US
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Telephone | 757-430-8828
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Fax | 757-430-8189
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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 | 2305206019
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License Number State | VA
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