Provider Demographics
NPI:1609879212
Name:CULLISON, TERRI SUE (PT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:SUE
Last Name:CULLISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:S
Other - Last Name:LOUSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-358-9494
Mailing Address - Fax:515-358-9491
Practice Address - Street 1:12493 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8286
Practice Address - Country:US
Practice Address - Phone:515-358-9494
Practice Address - Fax:515-358-9491
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15401Medicare PIN