Provider Demographics
NPI:1942781372
Name:CUSHMAN, KAYLA JILL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JILL
Last Name:CUSHMAN
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 1:3 BISCO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281-6524
Mailing Address - Country:US
Mailing Address - Phone:207-890-0678
Mailing Address - Fax:
Practice Address - Street 1:477 HIGH ST
Practice Address - Street 2:
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281-6507
Practice Address - Country:US
Practice Address - Phone:207-743-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist