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General NPI Number Information
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NPI Number | 1407122310
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Entity Type | Organization
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Legal Business Name | PHOENIX THERAPIES, LLC
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Dates
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Enumeration Date | 03/25/2012
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Last Update Date | 03/25/2012
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Provider Practice Location Address
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Address Line | 14 E MAIN ST SUITE 108
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City | WENTZVILLE
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State | MO
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Zip | 63385-1735
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Country | US
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Telephone | 636-327-6983
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Fax | 636-327-6984
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Provider Business Mailing Address
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Address Line | 14 E MAIN ST SUITE 108
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City | WENTZVILLE
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State | MO
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Zip | 63385-1735
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Country | US
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Telephone | 636-327-6983
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Fax | 636-327-6984
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Authorized Official
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Title or Position | CEO
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Name | MR. CHRISTOPHER W KUEBLER
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Credential | PT
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Telephone | 636-327-6983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | MO
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