Healthcare Provider Details

I. General information

NPI: 1366081168
Provider Name (Legal Business Name): KUZMA PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 ROUTE 19 N STE E
WATERFORD PA
16441-9739
US

IV. Provider business mailing address

46 ROSEWOOD LN
GROVE CITY PA
16127-4550
US

V. Phone/Fax

Practice location:
  • Phone: 814-796-3400
  • Fax: 814-796-8533
Mailing address:
  • Phone: 724-458-9473
  • Fax: 724-458-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT A WISE
Title or Position: PRESIDENT
Credential: DPT
Phone: 724-458-9473