Provider Demographics
NPI:1821386335
Name:KUCHARSKI, GREGORY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:KUCHARSKI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 FAIRVIEW RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3102
Mailing Address - Country:US
Mailing Address - Phone:980-224-7958
Mailing Address - Fax:
Practice Address - Street 1:5960 FAIRVIEW RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3102
Practice Address - Country:US
Practice Address - Phone:980-224-7958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010036225100000X
SC6515225100000X
NCP15283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist