Individual
MRS. ANGELA J CUSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
3101 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3743
(217) 366-1323
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3981
(217) 366-1323
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070024735
IL
2251X0800X
Orthopedic Physical Therapist
1102679
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070024735
PROFESSIONAL LICENSE
IL
Enumeration date
02/08/2006
Last updated
10/30/2024
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