Healthcare Provider Details

I. General information

NPI: 1447467550
Provider Name (Legal Business Name): LISA R KUCHAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 S MAIN ST SUITES A & B
SUGAR GROVE IL
60554-5031
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 630-466-5866
  • Fax: 630-466-5869
Mailing address:
  • Phone: 631-580-5200
  • Fax: 631-580-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070011063
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: