Provider Demographics
NPI:1982159216
Name:MCCUSKEY, KYLE (ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MCCUSKEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N QUAKER LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-3004
Mailing Address - Country:US
Mailing Address - Phone:703-933-4089
Mailing Address - Fax:
Practice Address - Street 1:1200 N QUAKER LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-3004
Practice Address - Country:US
Practice Address - Phone:703-933-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17962255A2300X
MN28492255A2300X
VA01260031482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer