Healthcare Provider Details

I. General information

NPI: 1356491062
Provider Name (Legal Business Name): LAUREL ANN KUEBLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREL ANN MCKINNY PT

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N DIERS AVE SUITE 300
GRAND ISLAND NE
68803-4984
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax: 308-382-3241
Mailing address:
  • Phone: 308-382-0344
  • Fax: 308-382-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05007727A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3486
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: