Provider Demographics
NPI:1366169732
Name:CUSTER, CONOR STEVEN (MS, ATC, TSAC-F)
Entity type:Individual
Prefix:MR
First Name:CONOR
Middle Name:STEVEN
Last Name:CUSTER
Suffix:
Gender:M
Credentials:MS, ATC, TSAC-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:NEW FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:17349-9487
Mailing Address - Country:US
Mailing Address - Phone:717-891-4208
Mailing Address - Fax:
Practice Address - Street 1:12 HARRISON RD
Practice Address - Street 2:
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-9487
Practice Address - Country:US
Practice Address - Phone:717-891-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer