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General NPI Number Information
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NPI Number | 1063371078
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Entity Type | Individual
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Provider Name | GAVIN SCOTT CUSSON PTA
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Gender | Male
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 9852 BUSINESS PARK DR STE A
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City | SACRAMENTO
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State | CA
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Zip | 95827-1709
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Country | US
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Telephone | 916-362-7962
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Fax |
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Provider Business Mailing Address
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Address Line | 3413 LERWICK RD
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City | SACRAMENTO
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State | CA
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Zip | 95821-1910
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Country | US
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Telephone | 605-593-2239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 54579
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License Number State | CA
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