MEDICARE: KEVIN M. HESSE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	017353-1	NY
2	225100000X	Physical Therapist	2305210751	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C05954	OTHER	VA	GROUP MEDICARE PTAN
3	Q56530A	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104819812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN M. HESSE P.T.

Provider Business Mailing Address
First Line	:	PO BOX 69030
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-0930
Country	:	US
Telephone Number	:	757-873-2302
Fax Number	:	757-873-2306

Provider Business Practice Location Address
First Line	:	4020 RAINTREE RD
Second Line	:	SUITE D
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-3749
Country	:	US
Telephone Number	:	757-484-4241
Fax Number	:	757-484-4487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2005
Last Update Date	:	04/16/2018

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Directions to “ KEVIN M. HESSE P.T.” Practice Location

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