Healthcare Provider Details

I. General information

NPI: 1942481205
Provider Name (Legal Business Name): LARISA KUCHTA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 JEFFERSON ST
NAPA CA
94559-1708
US

IV. Provider business mailing address

5980 STONERIDGE DR STE 100
PLEASANTON CA
94588-4518
US

V. Phone/Fax

Practice location:
  • Phone: 707-251-9716
  • Fax:
Mailing address:
  • Phone: 925-457-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT27855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: