Provider Demographics
NPI:1104895200
Name:SCHUSSLER, ERIC J (PHD, PT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:SCHUSSLER
Suffix:
Gender:M
Credentials:PHD, PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2116
Mailing Address - Country:US
Mailing Address - Phone:412-389-1041
Mailing Address - Fax:402-436-2996
Practice Address - Street 1:3300 AZALEA GARDEN RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2239
Practice Address - Country:US
Practice Address - Phone:412-389-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017332225100000X
NE2744225100000X
VA2305210224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39677OtherBCBS
NE098787003Medicare UPIN