MEDICARE: MR. GEOFFREY ALLERTON CUSHMAN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	012100	NY

General Provider Information

NPI Number	:	1528257649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEOFFREY ALLERTON CUSHMAN P.T.

Provider Business Mailing Address
First Line	:	PO BOX 521419
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11352-1419
Country	:	US
Telephone Number	:	212-470-7505
Fax Number	:

Provider Business Practice Location Address
First Line	:	2488 GRAND CONCOURSE
Second Line	:	STE 425
City	:	BRONX
State	:	NY
Zip	:	10458-5203
Country	:	US
Telephone Number	:	212-470-7505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	08/17/2016

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