=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053825737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KUHN PHYSICAL THERAPY AND WELLNESS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2017
-----------------------------------------------------
Last Update Date | 07/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4879 CORONADO AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92107-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-895-8094
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4876 SANTA MONICA AVE # 204
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92107-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-578-2880
-----------------------------------------------------
Fax | 619-578-2880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/FOUNDING MEMBER
-----------------------------------------------------
Name | DR. SEAN WILLIAM KUHN JR.
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 619-895-8094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40879
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------