Provider Demographics
NPI:1629449673
Name:VAN KEMPEN, BRANDON
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:VAN KEMPEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S HARBOR CITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1936
Mailing Address - Country:US
Mailing Address - Phone:321-802-5810
Mailing Address - Fax:321-802-5811
Practice Address - Street 1:709 S HARBOR CITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1936
Practice Address - Country:US
Practice Address - Phone:321-802-5810
Practice Address - Fax:321-802-5811
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLYZX3GOtherBLUE CROSS BLUE SHIELD OF FLORIDA