Healthcare Provider Details

I. General information

NPI: 1568732790
Provider Name (Legal Business Name): JODI KUTCHER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE BELLEVUE HOSPITAL CENTER
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 1ST AVENUE
NEW YORK NEW YORK
10016
UM

V. Phone/Fax

Practice location:
  • Phone: 212-562-7059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number034242-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: