Provider Demographics
NPI:1518900398
Name:KUCHTA, CHRIS (PT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:KUCHTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 VALLEY CENTER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2950
Practice Address - Country:US
Practice Address - Phone:302-994-1200
Practice Address - Fax:302-994-1233
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2287776000OtherAMERIHEALTH IBC
62085201OtherNCA
DE1000038253Medicaid
2287776000OtherAMERIHEALTH
1610157OtherPABS
5070-0037OtherCAREFIRST
2287776000OtherAMERIHEALTH
2287776000OtherAMERIHEALTH IBC
5070-0037OtherCAREFIRST
MD822M1901Medicare ID - Type Unspecified
DE012598F68Medicare ID - Type Unspecified