Provider Demographics
NPI:1023137338
Name:KUSSRO, NORA MORALES (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:NORA
Middle Name:MORALES
Last Name:KUSSRO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9341 SNOW BEAR DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-6948
Mailing Address - Country:US
Mailing Address - Phone:907-301-2480
Mailing Address - Fax:
Practice Address - Street 1:9341 SNOW BEAR DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-6948
Practice Address - Country:US
Practice Address - Phone:907-301-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT4513Medicaid