Provider Demographics
NPI:1538400627
Name:CALUSCUSAO, ERIK ALEXANDER PERNES (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ERIK ALEXANDER
Middle Name:PERNES
Last Name:CALUSCUSAO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 OWEN LN APT 911
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-8915
Mailing Address - Country:US
Mailing Address - Phone:509-386-2091
Mailing Address - Fax:
Practice Address - Street 1:415 OWEN LN APT 911
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710
Practice Address - Country:US
Practice Address - Phone:509-386-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1214150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist