Tanner Cusick

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1403327 Issued in KS

Practice address

608 N Mulberry Rd
Derby, KS 67037-3532

Phone

(316) 202-0996

Fax

(316) 202-0997

NPI assigned

Dec 20, 2017

Last updated

Dec 20, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513728000000",
    "number": "1346756863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS AVE STE 1040",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023017",
            "telephone_number": "316-263-0003",
            "fax_number": "316-263-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 N MULBERRY RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373532",
            "telephone_number": "316-202-0996",
            "fax_number": "316-202-0997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSICK",
        "first_name": "TANNER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-20",
        "last_updated": "2017-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KS",
            "license": "1403327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Debbie M Deboard, SLP
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• Physical Therapy Assistant in Derby, KS
• Providers in Derby, KS by specialty
• Physical Therapy Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.