Provider Demographics
NPI:1679870364
Name:KUSEK, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KUSEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6279 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-5332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6279 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:FORT CALHOUN
Practice Address - State:NE
Practice Address - Zip Code:68023-5332
Practice Address - Country:US
Practice Address - Phone:402-415-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR06352OtherSTATE OF OREGON DEPT OF HEALTH
NE2907OtherSTATE OF NEBRASKA DEPT OF HEALTH
AKPHY P 2243OtherSTATE OF ALASKA DEPT OF HEALTH
FL26025OtherSTATE OF FLORIDA DEPT OF HEALTH