Healthcare Provider Details

I. General information

NPI: 1720064355
Provider Name (Legal Business Name): WILLIAM HENRY TUSSY RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 PASEO DEL NORTE SUITE D-1
CARLSBAD CA
92011-1150
US

IV. Provider business mailing address

3820 MONROE ST
CARLSBAD CA
92008-2734
US

V. Phone/Fax

Practice location:
  • Phone: 760-268-0702
  • Fax: 760-268-0704
Mailing address:
  • Phone: 760-720-9774
  • Fax: 760-268-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 14189
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 14189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: