Provider Demographics
NPI:1710291281
Name:KUCHTA, LUCAS GUSTAV (PT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:GUSTAV
Last Name:KUCHTA
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:5310 HAUSERMAN RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1234
Practice Address - Country:US
Practice Address - Phone:440-882-6220
Practice Address - Fax:440-882-6220
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist