MEDICARE: JKH MANAGEMENT, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1467698068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JKH MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	15 APEX DR
Second Line	:
City	:	HIGHLAND
State	:	IL
Zip	:	62249-1282
Country	:	US
Telephone Number	:	618-651-0444
Fax Number	:	618-654-5439

Provider Business Practice Location Address
First Line	:	1138 VAUGHN ROAD
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095
Country	:	US
Telephone Number	:	618-651-0444
Fax Number	:	618-654-5439

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	JOHN HETTENHAUSEN
Credential	:	MBA,OTR/L
Telephone Number	:	618-651-0444

Provider Enumeration Date	:	01/02/2009
Last Update Date	:	01/21/2009

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