Provider Demographics
NPI:1619741139
Name:KEMPSVILLE WELLNESS LLC
Entity Type:Organization
Organization Name:KEMPSVILLE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARTEMIS
Authorized Official - Middle Name:GEORGIA
Authorized Official - Last Name:TRYPHONAS
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS
Authorized Official - Phone:757-318-1598
Mailing Address - Street 1:810 KEMPSVILLE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2723
Mailing Address - Country:US
Mailing Address - Phone:757-318-1598
Mailing Address - Fax:757-366-0129
Practice Address - Street 1:810 KEMPSVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2723
Practice Address - Country:US
Practice Address - Phone:757-318-1598
Practice Address - Fax:757-366-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty