Provider Demographics
NPI:1063537843
Name:KUSH, STEPHEN E (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:KUSH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 E BASELINE RD
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1510
Mailing Address - Country:US
Mailing Address - Phone:480-833-1005
Mailing Address - Fax:480-833-1312
Practice Address - Street 1:7331 E OSBORN DR
Practice Address - Street 2:SUITE 190
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6435
Practice Address - Country:US
Practice Address - Phone:480-874-4212
Practice Address - Fax:480-874-4917
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6496225100000X
AZ0274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ050766Medicaid
AZ050766Medicaid
AZZ79354Medicare PIN
AZZ102616Medicare PIN
AZ127047Medicare PIN