MEDICARE: KENT INTEGRATIVE PHYSICAL THERAPY 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	261QR0400X	Rehabilitation Clinic/Center	2305208118	VA
2	261QP2000X	Physical Therapy Clinic/Center	2305208118	VA

General Provider Information

NPI Number	:	1275067001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT INTEGRATIVE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	3616 ROYAL PALM ARCH
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3608
Country	:	US
Telephone Number	:	757-447-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	3616 ROYAL PALM ARCH
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3608
Country	:	US
Telephone Number	:	804-922-6505
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	SHIRLEY KENT
Credential	:	DPT
Telephone Number	:	757-447-7278

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	07/27/2017

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