Provider Demographics
NPI:1700215902
Name:KUKUVKA, CORY (PT, DPT, CLT)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:KUKUVKA
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 BATHGATE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7336
Mailing Address - Country:US
Mailing Address - Phone:484-884-2251
Mailing Address - Fax:
Practice Address - Street 1:1770 BATHGATE RD STE 300
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7336
Practice Address - Country:US
Practice Address - Phone:484-884-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist