Active NPI
Marko Steven Kustudia, DPT
- Physical Therapist
- Henderson, NV
National Provider Identifier
1710133319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 41894
- Practice address
- 2779 W. Horizon Ridge Pkwy
#100
Henderson, NV 89052-4185 - Phone
- (702) 897-1222
- Fax
- (702) 897-1252
- NPI assigned
- Aug 14, 2008
- Last updated
- Oct 16, 2015
- Sex
- Male
- 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 | 41894 | CA | Primary |
Addresses
Primary practice location
2779 W. Horizon Ridge Pkwy
#100
Henderson, NV 89052-4185
Mailing address
6440 Medical Center St
#100
Las Vegas, NV 89148-2404
Phone (702) 222-1000
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 |
|---|---|---|---|
| 41894 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Executive Fitness Inc | Physical Therapist | Past | Accepting new patients |
| Executive Fitness Inc | Past | Accepting new patients | |
| Silver Creek Fitness and Physical Therapy | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Timothy B Soder Physical Therapy
- Physical Therapist
- Las Vegas, NV
- NPI 1881710192
-
dba Silver Creek Physical Therapy
- Physical Therapist
- San Jose, CA
- NPI 1063510337
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444953600000",
"number": "1710133319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6440 MEDICAL CENTER ST",
"address_2": "#100",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891482404",
"telephone_number": "702-222-1000",
"fax_number": "702-222-9448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2779 W. HORIZON RIDGE PKWY",
"address_2": "#100",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890524185",
"telephone_number": "702-897-1222",
"fax_number": "702-897-1252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUSTUDIA",
"first_name": "MARKO",
"middle_name": "STEVEN",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-14",
"last_updated": "2015-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "41894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.