Provider Demographics
NPI:1093490203
Name:CUSHMAN, SPENCER THOMAS
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:THOMAS
Last Name:CUSHMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1127
Mailing Address - Country:US
Mailing Address - Phone:303-280-3838
Mailing Address - Fax:303-280-3838
Practice Address - Street 1:13370 E MARY ANN CLEVELAND WAY STE 130
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-8611
Practice Address - Country:US
Practice Address - Phone:520-689-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215852225100000X
COPTL.0020450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist