Provider Demographics
NPI:1598716383
Name:KUCHARSKI, SCOTT THOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:THOMAS
Last Name:KUCHARSKI
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 1:321 WINDHAM CT
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4209
Mailing Address - Country:US
Mailing Address - Phone:440-740-0743
Mailing Address - Fax:216-901-2803
Practice Address - Street 1:5000 ROCKSIDE RD STE 500
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2178
Practice Address - Country:US
Practice Address - Phone:216-459-2846
Practice Address - Fax:216-901-2803
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT006279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11389647OtherCAQH
OH2361260Medicaid
OH11389647OtherCAQH