Provider Demographics
NPI:1992081780
Name:KUEHN, TABITHA (PT)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:
Last Name:KUEHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:HANNUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2910 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:602-406-3008
Mailing Address - Fax:602-406-6108
Practice Address - Street 1:10245 N 92ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4563
Practice Address - Country:US
Practice Address - Phone:480-767-0555
Practice Address - Fax:480-704-3373
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ675462Medicaid
AZZ155068Medicare PIN