MEDICARE: TERRI SUE CULLISON PT

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	01568	IA

General Provider Information

NPI Number	:	1609879212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI SUE CULLISON PT

Provider Business Mailing Address
First Line	:	PO BOX 1475
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50305-1475
Country	:	US
Telephone Number	:	515-358-9494
Fax Number	:	515-358-9491

Provider Business Practice Location Address
First Line	:	12493 UNIVERSITY AVE
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-8286
Country	:	US
Telephone Number	:	515-358-9494
Fax Number	:	515-358-9491

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/25/2019

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Directions to “ TERRI SUE CULLISON PT” Practice Location

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