Provider Demographics
NPI:1154753291
Name:USHER, KEVIN (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:USHER
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 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:
Practice Address - Street 1:994 W SHERMAN AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6937
Practice Address - Country:US
Practice Address - Phone:856-696-0900
Practice Address - Fax:856-692-4769
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA014983002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic