Provider Demographics
NPI:1639296346
Name:KUSHNER, SUSAN ROBERTA (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ROBERTA
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 DWELLINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059-2513
Mailing Address - Country:US
Mailing Address - Phone:724-584-6595
Mailing Address - Fax:724-738-2113
Practice Address - Street 1:205 DWELLINGTON CIR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:PA
Practice Address - Zip Code:16059-2513
Practice Address - Country:US
Practice Address - Phone:724-584-6595
Practice Address - Fax:724-738-2113
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist