Provider Demographics
NPI:1588748412
Name:MARUSIK-CUMMINS, JENNIFER RENEA (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEA
Last Name:MARUSIK-CUMMINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RENEA
Other - Last Name:MARUSIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15400 SOUTHWEST FWY STE 310
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3875
Mailing Address - Country:US
Mailing Address - Phone:832-828-1843
Mailing Address - Fax:281-494-0032
Practice Address - Street 1:15400 SOUTHWEST FWY STE 310
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3875
Practice Address - Country:US
Practice Address - Phone:832-828-1843
Practice Address - Fax:281-494-0032
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1128999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist