Provider Demographics
NPI:1679538227
Name:CUSICK, BEVERLY (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:CUSICK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:CUSICK
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPY
Mailing Address - Street 1:305 SOCIETY DR
Mailing Address - Street 2:C-3
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-8936
Mailing Address - Country:US
Mailing Address - Phone:970-728-7078
Mailing Address - Fax:970-728-7028
Practice Address - Street 1:305 SOCIETY DR
Practice Address - Street 2:C-3
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-8936
Practice Address - Country:US
Practice Address - Phone:970-728-7078
Practice Address - Fax:970-728-7028
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43322251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics