Provider Demographics
NPI:1548463151
Name:KUSNER, SUSAN (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:KUSNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1506
Mailing Address - Country:US
Mailing Address - Phone:313-274-4006
Mailing Address - Fax:
Practice Address - Street 1:13020 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3640
Practice Address - Country:US
Practice Address - Phone:313-827-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003678174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501003678OtherPHYSICAL THERAPY LICENSE