MEDICARE: MR. MICHAEL SCOTT KUENNING MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	B2000006158	CA
2	225100000X	Physical Therapist	4135	NV

General Provider Information

NPI Number	:	1043304702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL SCOTT KUENNING MPT

Provider Business Mailing Address
First Line	:	3704 RUFFIN RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1812
Country	:	US
Telephone Number	:	858-278-3633
Fax Number	:	858-278-4375

Provider Business Practice Location Address
First Line	:	4270 S DECATUR BLVD STE A5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6801
Country	:	US
Telephone Number	:	702-509-5098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/26/2020

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