Provider Demographics
NPI:1356326334
Name:JUSKO, RICHARD JARRETT (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JARRETT
Last Name:JUSKO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 106TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8614
Mailing Address - Country:US
Mailing Address - Phone:425-454-4864
Mailing Address - Fax:425-646-3901
Practice Address - Street 1:4220 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2317
Practice Address - Country:US
Practice Address - Phone:425-258-5330
Practice Address - Fax:425-258-6118
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00748163OtherRAILROAD MEDICARE
WA8343253Medicaid
WA8335820Medicaid
WAP00748163OtherRAILROAD MEDICARE
WA8335820Medicaid