MEDICARE: KEMPSVILLE PHYSICAL THERAPY P C

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	2305002340	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	239374	OTHER	VA	BC BS

General Provider Information

NPI Number	:	1437202793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEMPSVILLE PHYSICAL THERAPY P C

Provider Business Mailing Address
First Line	:	5265 PROVIDENCE RD
Second Line	:	SUITE 503
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4206
Country	:	US
Telephone Number	:	757-961-7430
Fax Number	:	757-523-4653

Provider Business Practice Location Address
First Line	:	5265 PROVIDENCE RD
Second Line	:	SUITE 503
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4206
Country	:	US
Telephone Number	:	757-523-4705
Fax Number	:	757-523-4653

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LINDA CAROL NIECE-BOAZ
Credential	:	P.T.
Telephone Number	:	757-523-4705

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	02/23/2016

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Directions to “KEMPSVILLE PHYSICAL THERAPY P C ” Practice Location

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