Healthcare Provider Details

I. General information

NPI: 1982413092
Provider Name (Legal Business Name): SOFIA KUCINSKAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 E MICHIGAN AVE STE 400
SALINE MI
48176-2700
US

IV. Provider business mailing address

7115 E MICHIGAN AVE STE 400
SALINE MI
48176-2700
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-5151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502008046
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: