MEDICARE: JAMES KUSEK

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	26025	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06352	OTHER	OR	STATE OF OREGON DEPT OF HEALTH
2	2907	OTHER	NE	STATE OF NEBRASKA DEPT OF HEALTH
3	PHY P 2243	OTHER	AK	STATE OF ALASKA DEPT OF HEALTH
4	26025	OTHER	FL	STATE OF FLORIDA DEPT OF HEALTH

General Provider Information

NPI Number	:	1679870364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KUSEK

Provider Business Mailing Address
First Line	:	6279 N RIDGE RD
Second Line	:
City	:	FORT CALHOUN
State	:	NE
Zip	:	68023-5332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6279 N RIDGE RD
Second Line	:
City	:	FORT CALHOUN
State	:	NE
Zip	:	68023-5332
Country	:	US
Telephone Number	:	402-415-1396
Fax Number	:

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

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	02/16/2011

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Directions to “ JAMES KUSEK ” Practice Location

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