Healthcare Provider Details

I. General information

NPI: 1215866546
Provider Name (Legal Business Name): MATTHEW HUNGERFORD KUBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W BATTLEFIELD ST
SPRINGFIELD MO
65807-4162
US

IV. Provider business mailing address

1400 W BATTLEFIELD ST
SPRINGFIELD MO
65807-4162
US

V. Phone/Fax

Practice location:
  • Phone: 417-889-6869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2023015884
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: