Healthcare Provider Details

I. General information

NPI: 1326169723
Provider Name (Legal Business Name): K.B.THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S JOHNSON ST SUITE 1
KAHOKA MO
63445-1608
US

IV. Provider business mailing address

500 S JOHNSON ST SUITE 1 P.O. BOX 16
KAHOKA MO
63445-1608
US

V. Phone/Fax

Practice location:
  • Phone: 660-727-3766
  • Fax: 660-727-3799
Mailing address:
  • Phone: 660-727-3766
  • Fax: 660-727-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberR1127
License Number StateMO

VIII. Authorized Official

Name: KIMBERLY ANN BUNTEN
Title or Position: PRESIDENT
Credential: P.T.
Phone: 573-769-6166