Provider Demographics
NPI:1285200378
Name:KUHL, EVAN (PT, DPT, XPS, USAW-1)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:KUHL
Suffix:
Gender:M
Credentials:PT, DPT, XPS, USAW-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-5966
Mailing Address - Country:US
Mailing Address - Phone:779-208-0785
Mailing Address - Fax:
Practice Address - Street 1:10407 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:MO
Practice Address - Zip Code:63131-2909
Practice Address - Country:US
Practice Address - Phone:314-432-6103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020032498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist