Doctor Name: | BEVERLY CUSICK |
NPI Number: | 1679538227 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHYSICAL THERAPY |
License Number: | 4332 |
Business Practice Address: | 305 Society Dr C-3 Telluride, CO - 814358936 |
Business Phone Number: | 9707287078 |
Business Fax Number: | 9707287028 |
Mailing Address: | 305 Society Dr, C-3 TELLURIDE |
State: | CO |
Postal Code: | 814358936 |
Phone Number: | 9707287078 |
Fax Number: | 9707287028 |
NPI Enumeration Date: | 04/18/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251P0200X |
License Number: | 4332 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |