MEDICARE: KYLE MCCUSKEY ATC

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	2255A2300X	Athletic Trainer	1796	MN
2	2255A2300X	Athletic Trainer	2849	MN
3	2255A2300X	Athletic Trainer	0126003148	VA

General Provider Information

NPI Number	:	1982159216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE MCCUSKEY ATC

Provider Business Mailing Address
First Line	:	1200 N QUAKER LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-3004
Country	:	US
Telephone Number	:	703-933-4089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N QUAKER LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-3004
Country	:	US
Telephone Number	:	703-933-4089
Fax Number	:

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

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	08/12/2021

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Directions to “ KYLE MCCUSKEY ATC” Practice Location

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