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NPI Code Detail

MEDICARE: CARMEN R CUSIC PT

MEDICARE:   CARMEN R CUSIC  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
1225100000XPhysical Therapist004162KY
2225100000XPhysical Therapist05006727AIN

General Provider Information

NPI Number : 1982850897
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARMEN R CUSIC PT
Provider Business Mailing Address
First Line : 851 KIMSEY LN
Second Line :
City : HENDERSON
State : KY
Zip : 42420-2665
Country : US
Telephone Number : 270-826-6436
Fax Number : 270-826-8893
Provider Business Practice Location Address
First Line : 851 KIMSEY LN
Second Line :
City : HENDERSON
State : KY
Zip : 42420-2665
Country : US
Telephone Number : 270-826-6436
Fax Number : 270-826-8893
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2008
Last Update Date : 08/12/2008

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Directions to “ CARMEN R CUSIC PT” Practice Location

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