Provider Demographics
NPI:1710133319
Name:KUSTUDIA, MARKO STEVEN (DPT)
Entity Type:Individual
Prefix:MR
First Name:MARKO
Middle Name:STEVEN
Last Name:KUSTUDIA
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Gender:M
Credentials:DPT
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Mailing Address - Street 1:6440 MEDICAL CENTER ST
Mailing Address - Street 2:#100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2404
Mailing Address - Country:US
Mailing Address - Phone:702-222-1000
Mailing Address - Fax:702-222-9448
Practice Address - Street 1:2779 W. HORIZON RIDGE PKWY
Practice Address - Street 2:#100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4185
Practice Address - Country:US
Practice Address - Phone:702-897-1222
Practice Address - Fax:702-897-1252
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2015-10-16
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Provider Licenses
StateLicense IDTaxonomies
CA41894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBH088Medicare UPIN
NVBH088Medicare PIN