Provider Demographics
NPI:1306105044
Name:CUSTER, BRYTNEY VALENTINE (PTA)
Entity type:Individual
Prefix:MISS
First Name:BRYTNEY
Middle Name:VALENTINE
Last Name:CUSTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7966 NUMBER 4 RD W
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9540
Mailing Address - Country:US
Mailing Address - Phone:315-663-6980
Mailing Address - Fax:
Practice Address - Street 1:7966 NUMBER 4 RD W
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9540
Practice Address - Country:US
Practice Address - Phone:315-663-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603236225200000X
NY008043-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant