Healthcare Provider Details

I. General information

NPI: 1598716383
Provider Name (Legal Business Name): SCOTT THOMAS KUCHARSKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 ROCKSIDE RD STE 500
INDEPENDENCE OH
44131-2178
US

IV. Provider business mailing address

321 WINDHAM CT
BROADVIEW HTS OH
44147-4209
US

V. Phone/Fax

Practice location:
  • Phone: 216-459-2846
  • Fax: 216-901-2803
Mailing address:
  • Phone: 440-740-0743
  • Fax: 216-901-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006279
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: