Healthcare Provider Details

I. General information

NPI: 1427376953
Provider Name (Legal Business Name): HEATHER KUCZYNSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35746 HARPER ST
CLINTON TWP. MI
48035
US

IV. Provider business mailing address

35746 HARPER ST
CLINTON TWP. MI
48035
US

V. Phone/Fax

Practice location:
  • Phone: 989-529-3009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberL1711222
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: