Healthcare Provider Details

I. General information

NPI: 1043304702
Provider Name (Legal Business Name): MICHAEL SCOTT KUENNING MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 RUFFIN RD STE 203
SAN DIEGO CA
92123-1338
US

IV. Provider business mailing address

PO BOX 26362
SAN DIEGO CA
92196-0362
US

V. Phone/Fax

Practice location:
  • Phone: 858-324-5505
  • Fax: 858-724-3279
Mailing address:
  • Phone: 858-324-5505
  • Fax: 858-724-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberB2000006158
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4135
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: