Provider Demographics
NPI:1245906932
Name:KUCZAJ, LAURA (LMT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:KUCZAJ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LARCH CV
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5724
Mailing Address - Country:US
Mailing Address - Phone:512-618-1568
Mailing Address - Fax:
Practice Address - Street 1:113 LARCH CV
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5724
Practice Address - Country:US
Practice Address - Phone:512-618-1568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT106519225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist