Provider Demographics
NPI:1811961295
Name:CUSHING, KRISTIN
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CUSHING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SUNAPEE ST
Mailing Address - Street 2:UNIT ONE
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-5412
Mailing Address - Country:US
Mailing Address - Phone:603-863-3260
Mailing Address - Fax:603-863-3291
Practice Address - Street 1:360 SUNAPEE ST
Practice Address - Street 2:UNIT ONE
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-5412
Practice Address - Country:US
Practice Address - Phone:603-863-3260
Practice Address - Fax:603-863-3291
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y007616NH01OtherANTHEM
NH30393090Medicaid
NH30393090Medicaid