=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366088072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KUEHNEL REHABILITATION SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2019
-----------------------------------------------------
Last Update Date | 04/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1887 N STATE HIGHWAY CC
-----------------------------------------------------
City | NIXA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65714-8015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-725-5774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4789 E TRAILWOOD WAY
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65809-4319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-225-8664
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TODD KUEHNEL
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 417-234-1612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------