Healthcare Provider Details

I. General information

NPI: 1710200704
Provider Name (Legal Business Name): LORI JEANNE KUCZYNSKI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 SOUTH FLORIDA AV
LAKELAND FL
33803
US

IV. Provider business mailing address

3440 SUMMERWOOD WAY
LAKELAND FL
33812-5019
US

V. Phone/Fax

Practice location:
  • Phone: 863-616-9800
  • Fax:
Mailing address:
  • Phone: 863-398-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA24415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: