Provider Demographics
NPI:1629839667
Name:KUCHARYSON, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KUCHARYSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 LAKE VERNA DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7193
Mailing Address - Country:US
Mailing Address - Phone:720-237-5756
Mailing Address - Fax:
Practice Address - Street 1:2923 LAKE VERNA DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7193
Practice Address - Country:US
Practice Address - Phone:720-237-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist