Active NPI
Mallow Fay McKusick, PT
- Physical Therapist
- Tucson, AZ
National Provider Identifier
1699112615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10310
- Practice address
- 4600 S Park Ave Ste 5
Tucson, AZ 85714-1697 - Phone
- (520) 889-9574
- NPI assigned
- May 31, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10310 | AZ | Primary |
Addresses
Primary practice location
4600 S Park Ave Ste 5
Tucson, AZ 85714-1697
Mailing address
4600 S Park Ave Ste 5
Tucson, AZ 85714-1697
Phone (520) 889-9574
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10310 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369958400000",
"number": "1699112615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4600 S PARK AVE STE 5",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857141697",
"telephone_number": "520-889-9574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4600 S PARK AVE STE 5",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857141697",
"telephone_number": "520-889-9574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKUSICK",
"first_name": "MALLOW",
"middle_name": "FAY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-31",
"last_updated": "2013-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "10310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.