Provider Demographics
NPI:1538786934
Name:KUZMICKAS, RUSNE (DPT)
Entity type:Individual
Prefix:
First Name:RUSNE
Middle Name:
Last Name:KUZMICKAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 N ST NW UNIT 120
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3595
Mailing Address - Country:US
Mailing Address - Phone:503-860-1441
Mailing Address - Fax:
Practice Address - Street 1:1902 CAMPUS COMMONS DR STE 120
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1582
Practice Address - Country:US
Practice Address - Phone:503-860-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist