Healthcare Provider Details

I. General information

NPI: 1043903271
Provider Name (Legal Business Name): MOLLY KUCHTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ATLANTIC AVE STE 1
OCEAN VIEW DE
19970-9166
US

IV. Provider business mailing address

PO BOX 392573
PITTSBURGH PA
15251-9573
US

V. Phone/Fax

Practice location:
  • Phone: 302-829-8508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-TT10996
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: