Healthcare Provider Details

I. General information

NPI: 1306955943
Provider Name (Legal Business Name): ROXANNE HUSSON-VAN NORMAN RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8344 CLAIREMONT MESA BLVD 110
SAN DIEGO CA
92111-1327
US

IV. Provider business mailing address

8344 CLAIREMONT MESA BLVD 110
SAN DIEGO CA
92111-1327
US

V. Phone/Fax

Practice location:
  • Phone: 858-565-6910
  • Fax: 858-565-6911
Mailing address:
  • Phone: 858-565-6910
  • Fax: 858-565-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18841
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT18841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: