Provider Demographics
NPI:1699030254
Name:KUSHNER, JEREMY T (MPT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:T
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 SILVER CREST RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-8906
Mailing Address - Country:US
Mailing Address - Phone:484-526-7355
Mailing Address - Fax:484-526-7356
Practice Address - Street 1:6651 SILVER CREST RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-8906
Practice Address - Country:US
Practice Address - Phone:484-526-7355
Practice Address - Fax:484-526-7356
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-022016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist