Provider Demographics
NPI:1285783647
Name:KUSS, JOHN KENNETH (PT, DPT, MTC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KENNETH
Last Name:KUSS
Suffix:
Gender:M
Credentials:PT, DPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 FORESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2413
Mailing Address - Country:US
Mailing Address - Phone:315-715-0203
Mailing Address - Fax:
Practice Address - Street 1:124 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-9760
Practice Address - Country:US
Practice Address - Phone:315-668-0123
Practice Address - Fax:315-668-0124
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4117Medicare ID - Type UnspecifiedJOHN KUSS MEDICARE #