Healthcare Provider Details

I. General information

NPI: 1184302077
Provider Name (Legal Business Name): EMILY KUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 US ROUTE 9
SCHROON LAKE NY
12870-2602
US

IV. Provider business mailing address

1176 US ROUTE 9
SCHROON LAKE NY
12870-2602
US

V. Phone/Fax

Practice location:
  • Phone: 610-742-9157
  • Fax:
Mailing address:
  • Phone: 610-742-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: