Healthcare Provider Details

I. General information

NPI: 1962767244
Provider Name (Legal Business Name): REBECCA LYNN KUEHL P.T, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 HIGHWAY 53 E SUIT 410 PMB 53
DAWSONVILLE GA
30534-6838
US

IV. Provider business mailing address

104 MEADOWLARK DR
MCDONOUGH GA
30253-6529
US

V. Phone/Fax

Practice location:
  • Phone: 770-781-4899
  • Fax:
Mailing address:
  • Phone: 478-714-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: