Provider Demographics
NPI:1407122310
Name:PHOENIX THERAPIES, LLC
Entity Type:Organization
Organization Name:PHOENIX THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:KUEBLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:636-327-6983
Mailing Address - Street 1:14 E MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1735
Mailing Address - Country:US
Mailing Address - Phone:636-327-6983
Mailing Address - Fax:636-327-6984
Practice Address - Street 1:14 E MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1735
Practice Address - Country:US
Practice Address - Phone:636-327-6983
Practice Address - Fax:636-327-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-25
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy