Provider Demographics
NPI:1023133725
Name:KUSEK, NICOLE F (MPT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:F
Last Name:KUSEK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 HIDDEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9357
Mailing Address - Country:US
Mailing Address - Phone:614-850-0091
Mailing Address - Fax:614-293-7648
Practice Address - Street 1:6048 WOODSVIEW WAY
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-6922
Practice Address - Country:US
Practice Address - Phone:614-293-6384
Practice Address - Fax:614-293-7648
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist