Provider Demographics
NPI:1619434776
Name:KEGLEY, JAMES PIERCE III (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PIERCE
Last Name:KEGLEY
Suffix:III
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ABBERLY CIR APT 2118
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3270
Mailing Address - Country:US
Mailing Address - Phone:804-572-4822
Mailing Address - Fax:
Practice Address - Street 1:4901 COGBILL RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-5307
Practice Address - Country:US
Practice Address - Phone:804-743-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAT030732255A2300X
VA1260035672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer