Provider Demographics
NPI:1164738027
Name:KPT LLC
Entity Type:Organization
Organization Name:KPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:319-239-5009
Mailing Address - Street 1:315 E SAN MARNAN DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5837
Mailing Address - Country:US
Mailing Address - Phone:319-239-5009
Mailing Address - Fax:
Practice Address - Street 1:315 E SAN MARNAN DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5837
Practice Address - Country:US
Practice Address - Phone:319-239-5009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-29
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02099261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI6239Medicare PIN