Healthcare Provider Details

I. General information

NPI: 1790032563
Provider Name (Legal Business Name): FAN HSU PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 N GARFIELD AVE 103
ALHAMBRA CA
91801-3556
US

IV. Provider business mailing address

41 N GARFIELD AVE 103
ALHAMBRA CA
91801-3556
US

V. Phone/Fax

Practice location:
  • Phone: 626-623-0343
  • Fax:
Mailing address:
  • Phone: 626-623-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: