Provider Demographics
NPI:1205011533
Name:MCCUSKER, JULIE (LMT,CSET)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:MCCUSKER
Suffix:
Gender:F
Credentials:LMT,CSET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 US 1
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-5652
Mailing Address - Country:US
Mailing Address - Phone:772-559-9459
Mailing Address - Fax:772-589-0316
Practice Address - Street 1:8130 US 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-5652
Practice Address - Country:US
Practice Address - Phone:772-559-9459
Practice Address - Fax:772-589-0316
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA19936225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA19936OtherBOARD OF MASSAGE