Provider Demographics
NPI:1528119484
Name:NUSSBAUM, KAREN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8446 CHIPPEWA RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1206
Mailing Address - Country:US
Mailing Address - Phone:917-626-5805
Mailing Address - Fax:
Practice Address - Street 1:8446 CHIPPEWA RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1206
Practice Address - Country:US
Practice Address - Phone:917-626-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020566225100000X
NM3323225100000X
PA028119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83374264Medicaid