Healthcare Provider Details

I. General information

NPI: 1659460558
Provider Name (Legal Business Name): ADAM MUEHL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 N ILLINOIS ST STE 9
FAIRVIEW HEIGHTS IL
62208-2700
US

IV. Provider business mailing address

13537 BARRETT PARKWAY DR SUITE 105
BALLWIN MO
63021-5899
US

V. Phone/Fax

Practice location:
  • Phone: 314-621-1416
  • Fax: 618-624-9330
Mailing address:
  • Phone: 314-821-9126
  • Fax: 314-821-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2006015804
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015475
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: