Healthcare Provider Details

I. General information

NPI: 1821386335
Provider Name (Legal Business Name): GREGORY KUCHARSKI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 FAIRVIEW RD SUITE 250
CHARLOTTE NC
28210-3102
US

IV. Provider business mailing address

5960 FAIRVIEW RD SUITE 250
CHARLOTTE NC
28210-3102
US

V. Phone/Fax

Practice location:
  • Phone: 980-224-7958
  • Fax:
Mailing address:
  • Phone: 980-224-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010036
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6515
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP15283
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: