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Individual

LOREN CUSHING

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
24947 HIGHWAY 126 STE D, VENETA, OR 97487-9551
(541) 935-8503
Mailing address
87812 OAK ISLAND DR, VENETA, OR 97487-9745

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00693
LICENSE#
OR
Enumeration date
11/01/2006
Last updated
07/08/2007
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