Basic Information
| Provider Information | |||||||||
| NPI: | 1467698068 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JKH MANAGEMENT, LLC | ||||||||
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| OtherOrganizationName: | APEX PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 APEX DR | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622491282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186510444 | ||||||||
| FaxNumber: | 6186545439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1138 VAUGHN ROAD | ||||||||
| Address2: | |||||||||
| City: | WOOD RIVER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186510444 | ||||||||
| FaxNumber: | 6186545439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2009 | ||||||||
| LastUpdateDate: | 01/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | HETTENHAUSEN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 6186510444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA,OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.