Provider Demographics
NPI:1205144797
Name:KUTUCHIEF, CARSON (DPT)
Entity type:Individual
Prefix:DR
First Name:CARSON
Middle Name:
Last Name:KUTUCHIEF
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 1:805 SE 3RD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1105
Mailing Address - Country:US
Mailing Address - Phone:330-603-1089
Mailing Address - Fax:954-533-5275
Practice Address - Street 1:805 SE 3RD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1105
Practice Address - Country:US
Practice Address - Phone:330-603-1089
Practice Address - Fax:954-533-5275
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL258082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic