Healthcare Provider Details

I. General information

NPI: 1942656962
Provider Name (Legal Business Name): SUSANNAH KUCHARSKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 S COOPER RD SUITE 101
GILBERT AZ
85233-7163
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 480-503-2100
  • Fax:
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12223
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: