=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336152552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KLEINMEYER PHYSICAL THERAPY AND REHAB SPECIALISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 03/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1416 W 55TH ST
-----------------------------------------------------
City | LA GRANGE HIGHLANDS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60525-6531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-710-6361
-----------------------------------------------------
Fax | 708-352-0548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3497
-----------------------------------------------------
City | STURTEVANT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53177-0300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-552-2996
-----------------------------------------------------
Fax | 866-245-8064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MR. DAVID G. KLEINMEYER
-----------------------------------------------------
Credential | PT, ATC/L
-----------------------------------------------------
Telephone | 800-710-6361
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------