Provider Demographics
NPI:1710531272
Name:KASUSKA, JOSEPH H JR (ATC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:KASUSKA
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14110 ROCKY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121
Mailing Address - Country:US
Mailing Address - Phone:484-467-2889
Mailing Address - Fax:
Practice Address - Street 1:19455 DEERFIELD AVE. SUITE 306
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-729-5010
Practice Address - Fax:703-729-5833
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260030712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7090975568OtherBOC OF ATHLETIC TRAINERS