MEDICARE: KPT LLC

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	261QP2000X	Physical Therapy Clinic/Center	02099	IA

General Provider Information

NPI Number	:	1164738027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KPT LLC

Provider Business Mailing Address
First Line	:	315 E SAN MARNAN DR
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5837
Country	:	US
Telephone Number	:	319-239-5009
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 E SAN MARNAN DR
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5837
Country	:	US
Telephone Number	:	319-239-5009
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY ALAN KEMP
Credential	:	MS PT
Telephone Number	:	319-239-5009

Provider Enumeration Date	:	08/29/2010
Last Update Date	:	03/23/2012

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Directions to “KPT LLC ” Practice Location

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