Provider Demographics
NPI:1669453379
Name:PUSEY, MERLON W (PT)
Entity Type:Individual
Prefix:MR
First Name:MERLON
Middle Name:W
Last Name:PUSEY
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:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-1311
Mailing Address - Country:US
Mailing Address - Phone:970-476-7510
Mailing Address - Fax:970-476-7511
Practice Address - Street 1:1295 WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4395
Practice Address - Country:US
Practice Address - Phone:970-476-7510
Practice Address - Fax:970-476-7511
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO2997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCE9033Medicare PIN