Provider Demographics
NPI:1669844619
Name:KUCHINA, LYUBOV
Entity Type:Individual
Prefix:
First Name:LYUBOV
Middle Name:
Last Name:KUCHINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYUBOV
Other - Middle Name:
Other - Last Name:KUCHINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:8655 W FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-3100
Mailing Address - Country:US
Mailing Address - Phone:773-653-8486
Mailing Address - Fax:
Practice Address - Street 1:8655W FOSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1214
Practice Address - Country:US
Practice Address - Phone:773-653-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227014294225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist