Provider Demographics
NPI:1275067001
Name:KENT INTEGRATIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:KENT INTEGRATIVE PHYSICAL THERAPY LLC
Other - Org Name:KENT INTEGRATIVE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-447-7278
Mailing Address - Street 1:3616 ROYAL PALM ARCH
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3608
Mailing Address - Country:US
Mailing Address - Phone:757-447-7278
Mailing Address - Fax:
Practice Address - Street 1:3616 ROYAL PALM ARCH
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3608
Practice Address - Country:US
Practice Address - Phone:804-922-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208118261QP2000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation