MEDICARE: KAYLA JORDAN DUPREE PT, DPT

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	2305214341	VA

General Provider Information

NPI Number	:	1891360921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA JORDAN DUPREE PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 412307
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-2307
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:	631-760-8306

Provider Business Practice Location Address
First Line	:	12610 PATRICK HENRY DR STE H
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23602-9538
Country	:	US
Telephone Number	:	757-847-1470
Fax Number	:	757-874-1472

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

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	05/24/2021

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