Provider Demographics
NPI:1821473059
Name:KRUCHESKY, PAUL (DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KRUCHESKY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4943
Mailing Address - Country:US
Mailing Address - Phone:252-495-6365
Mailing Address - Fax:252-300-0258
Practice Address - Street 1:183 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4943
Practice Address - Country:US
Practice Address - Phone:252-495-6365
Practice Address - Fax:252-300-0258
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist