Provider Demographics
NPI:1538598818
Name:KUSKIN, DONALD (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:KUSKIN
Suffix:
Gender:M
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 1:18090 SANTA ARABELLA ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5506
Mailing Address - Country:US
Mailing Address - Phone:440-725-9600
Mailing Address - Fax:
Practice Address - Street 1:2492 WALNUT AVE
Practice Address - Street 2:#140
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6953
Practice Address - Country:US
Practice Address - Phone:714-544-2188
Practice Address - Fax:714-544-2189
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist