Healthcare Provider Details

I. General information

NPI: 1659189280
Provider Name (Legal Business Name): VICKI FUSTON PHYSICAL THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35282 PERSANO PL
FALLBROOK CA
92028-7704
US

IV. Provider business mailing address

35282 PERSANO PL
FALLBROOK CA
92028-7704
US

V. Phone/Fax

Practice location:
  • Phone: 760-855-7334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICKI FUSTON
Title or Position: CEO
Credential: DPT
Phone: 760-855-7334