Individual
TANNER CUSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
608 N MULBERRY RD, DERBY, KS 67037-3532
(316) 202-0996
(316) 202-0997
Mailing address
200 W DOUGLAS AVE STE 1040, WICHITA, KS 67202-3017
(316) 263-0003
(316) 263-1241
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1403327
KS
Other
Enumeration date
12/20/2017
Last updated
12/20/2017
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