Provider Demographics
NPI:1720796550
Name:KUSS, JULIANA RAYE (DPT)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:RAYE
Last Name:KUSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 SHARVIEW CIR APT 636
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-6656
Mailing Address - Country:US
Mailing Address - Phone:203-565-9553
Mailing Address - Fax:
Practice Address - Street 1:1002 UNITY CT
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7878
Practice Address - Country:US
Practice Address - Phone:704-283-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP21767OtherNC BOARD OF PHYSICAL THERAPY EXAMINERS