Provider Demographics
NPI:1407008865
Name:MCCUSKEY, ANDREA E NASO (PT, MS, OCS)
Entity Type:Individual
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First Name:ANDREA
Middle Name:E NASO
Last Name:MCCUSKEY
Suffix:
Gender:M
Credentials:PT, MS, OCS
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Mailing Address - Street 1:120 CRAVEN ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078
Mailing Address - Country:US
Mailing Address - Phone:760-752-8678
Mailing Address - Fax:760-471-7928
Practice Address - Street 1:120 CRAVEN ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078
Practice Address - Country:US
Practice Address - Phone:760-752-8678
Practice Address - Fax:760-471-7928
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT14572A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT14572AMedicare PIN