Provider Demographics
NPI:1265590137
Name:KUSS PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:KUSS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MINETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-668-0123
Mailing Address - Street 1:124 US ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-9760
Mailing Address - Country:US
Mailing Address - Phone:315-668-0123
Mailing Address - Fax:315-668-0124
Practice Address - Street 1:124 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-9760
Practice Address - Country:US
Practice Address - Phone:315-668-0123
Practice Address - Fax:315-668-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019046225100000X
NY012711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02643841Medicaid
NYRA4117Medicare ID - Type UnspecifiedJOHN KUSS-PROVIDER #
NY02643841Medicaid
NYRA5790Medicare ID - Type UnspecifiedHEIDI HATHAWAY PROVIDER #
NY6246060001Medicare NSC