Provider Demographics
NPI:1790423788
Name:KUTKA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:KUTKA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTKA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-337-2731
Mailing Address - Street 1:135 CATHERINE COVE LOOP
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-8363
Mailing Address - Country:US
Mailing Address - Phone:501-337-2731
Mailing Address - Fax:
Practice Address - Street 1:135 CATHERINE COVE LOOP
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-8363
Practice Address - Country:US
Practice Address - Phone:501-337-2731
Practice Address - Fax:501-423-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty