Provider Demographics
NPI:1942418645
Name:KUCZMA, CARLENE NOELLE (MPT)
Entity type:Individual
Prefix:MRS
First Name:CARLENE
Middle Name:NOELLE
Last Name:KUCZMA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:CARLENE
Other - Middle Name:NOELLE
Other - Last Name:BARENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:137 SHAGBARK LN
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5281
Mailing Address - Country:US
Mailing Address - Phone:845-592-0739
Mailing Address - Fax:845-592-0739
Practice Address - Street 1:200 BOCES DR
Practice Address - Street 2:PINES BRIDGE SCHOOL
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4321
Practice Address - Country:US
Practice Address - Phone:914-248-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021717-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist