MEDICARE: BRANDON VAN KEMPEN

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	037049	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	YZX3G	OTHER	FL	BLUE CROSS BLUE SHIELD OF FLORIDA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629449673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON VAN KEMPEN

Provider Business Mailing Address
First Line	:	709 S HARBOR CITY BLVD STE 100
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-1936
Country	:	US
Telephone Number	:	321-802-5810
Fax Number	:	321-802-5811

Provider Business Practice Location Address
First Line	:	709 S HARBOR CITY BLVD STE 100
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-1936
Country	:	US
Telephone Number	:	321-802-5810
Fax Number	:	321-802-5811

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

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	07/21/2022

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Directions to “ BRANDON VAN KEMPEN ” Practice Location

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