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General NPI Number Information
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NPI Number | 1740102292
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Entity Type | Individual
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Provider Name | JONATHAN FITZGERALD CUSKEY LMT
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Gender | Male
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 325 NW 21ST AVE STE 102
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City | PORTLAND
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State | OR
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Zip | 97209-1179
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Country | US
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Telephone | 240-463-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 NW IRVING ST APT 311
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City | PORTLAND
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State | OR
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Zip | 97210-3846
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 29815
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License Number State | OR
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