Provider Demographics
NPI:1013145721
Name:MCCLUSKEY, NANCY B (PT MS, DPT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:PT MS, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13616 ESSENCE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4722
Mailing Address - Country:US
Mailing Address - Phone:858-692-6874
Mailing Address - Fax:
Practice Address - Street 1:13616 ESSENCE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4722
Practice Address - Country:US
Practice Address - Phone:858-692-6874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22945225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF595ZMedicare PIN
FLCF595YMedicare PIN