Provider Demographics
NPI:1942481205
Name:KUCHTA, LARISA (PT)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:KUCHTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 STONERIDGE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4518
Mailing Address - Country:US
Mailing Address - Phone:925-457-9980
Mailing Address - Fax:
Practice Address - Street 1:1403 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1708
Practice Address - Country:US
Practice Address - Phone:707-251-9716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist