Provider Demographics
NPI:1457520066
Name:KIUNISALA, JANICE (RPT)
Entity Type:Individual
Prefix:MISS
First Name:JANICE
Middle Name:
Last Name:KIUNISALA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5730
Mailing Address - Country:US
Mailing Address - Phone:573-620-7158
Mailing Address - Fax:
Practice Address - Street 1:821 AUBURN DR
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5730
Practice Address - Country:US
Practice Address - Phone:573-620-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007026362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist