Healthcare Provider Details

I. General information

NPI: 1568488070
Provider Name (Legal Business Name): KARIN KUCK BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EXECUTIVE PARK DR
ALBANY NY
12203-3718
US

IV. Provider business mailing address

21 HAWTHORNE AVE
DELMAR NY
12054-3118
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-2449
  • Fax: 518-489-2991
Mailing address:
  • Phone: 518-439-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number009771-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: