Provider Demographics
NPI:1205248887
Name:MCCLUSKEY, JAMES RUSSELL (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RUSSELL
Last Name:MCCLUSKEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:RUSSELL
Other - Middle Name:
Other - Last Name:MCCLUSKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1304 VINE ST
Mailing Address - Street 2:APT C
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 S PEARL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2645
Practice Address - Country:US
Practice Address - Phone:303-778-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist