MEDICARE: MR. DAVID KUCK PT DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	025601 0	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3943267	OTHER	NY	AETNA HMO
2	7109712	OTHER	NY	AETNA PPO

General Provider Information

NPI Number	:	1538134697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID KUCK PT DPT

Provider Business Mailing Address
First Line	:	31 MAIN RD
Second Line	:	STE 4
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-1953
Country	:	US
Telephone Number	:	631-208-2900
Fax Number	:	631-208-2929

Provider Business Practice Location Address
First Line	:	31 MAIN RD
Second Line	:	STE 4
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-1953
Country	:	US
Telephone Number	:	631-208-2900
Fax Number	:	631-208-2929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	01/05/2012

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