Provider Demographics
NPI:1174064422
Name:KUSH, MICHELLE (PT,MPT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:KUSH
Suffix:
Gender:F
Credentials:PT,MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 HAY ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15530-1455
Mailing Address - Country:US
Mailing Address - Phone:814-267-4212
Mailing Address - Fax:814-267-5535
Practice Address - Street 1:1404 HAY ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:PA
Practice Address - Zip Code:15530-1455
Practice Address - Country:US
Practice Address - Phone:814-267-4212
Practice Address - Fax:814-267-5535
Is Sole Proprietor?:No
Enumeration Date:2017-03-19
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008157L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist