Provider Demographics
NPI:1922417153
Name:KUSKIN, LAURA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KUSKIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DAHL DR
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9552
Mailing Address - Country:US
Mailing Address - Phone:201-981-8133
Mailing Address - Fax:
Practice Address - Street 1:2 CHANGEBRIDGE RD BLDG SUITEF
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8947
Practice Address - Country:US
Practice Address - Phone:973-917-3134
Practice Address - Fax:973-917-3138
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01570700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist