Basic Information
| Provider Information | |||||||||
| NPI: | 1295153112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUSAK | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1103 CYPRESS CREEK ROAD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129180044 | ||||||||
| FaxNumber: | 5129180045 | ||||||||
| Practice Location | |||||||||
| Address1: | 1103 CYPRESS CREEK ROAD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129180044 | ||||||||
| FaxNumber: | 5129180045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2014 | ||||||||
| LastUpdateDate: | 03/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2091220 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.