Provider Demographics
NPI:1063993343
Name:KEMP, MARK WARREN (PTA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WARREN
Last Name:KEMP
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HART DR
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:PA
Mailing Address - Zip Code:15046-4930
Mailing Address - Country:US
Mailing Address - Phone:412-330-9655
Mailing Address - Fax:
Practice Address - Street 1:951 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2349
Practice Address - Country:US
Practice Address - Phone:412-269-1101
Practice Address - Fax:412-269-4096
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTEI000025225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant