Provider Demographics
NPI:1710200704
Name:KUCZYNSKI, LORI JEANNE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JEANNE
Last Name:KUCZYNSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 SUMMERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-5019
Mailing Address - Country:US
Mailing Address - Phone:863-398-8870
Mailing Address - Fax:
Practice Address - Street 1:3020 SOUTH FLORIDA AV
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803
Practice Address - Country:US
Practice Address - Phone:863-616-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA24415225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA24415OtherLICENSED MASSAGE THERAPIST