Healthcare Provider Details

I. General information

NPI: 1538598818
Provider Name (Legal Business Name): DONALD KUSKIN PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2492 WALNUT AVE #140
TUSTIN CA
92780-6953
US

IV. Provider business mailing address

18090 SANTA ARABELLA ST
FOUNTAIN VALLEY CA
92708-5506
US

V. Phone/Fax

Practice location:
  • Phone: 714-544-2188
  • Fax: 714-544-2189
Mailing address:
  • Phone: 440-725-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: