Provider Demographics
NPI:1700295276
Name:MCCUISTION, KENT
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:MCCUISTION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 NE 50TH ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-0729
Mailing Address - Country:US
Mailing Address - Phone:316-992-3833
Mailing Address - Fax:
Practice Address - Street 1:5104 NE 50TH ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-0729
Practice Address - Country:US
Practice Address - Phone:316-992-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist