Healthcare Provider Details

I. General information

NPI: 1437211919
Provider Name (Legal Business Name): FUSION PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 VAN NUYS BLVD STE 314
SHERMAN OAKS CA
91403-1852
US

IV. Provider business mailing address

1560 NEWBURY RD STE 1 #253
NEWBURY PARK CA
91320-3448
US

V. Phone/Fax

Practice location:
  • Phone: 818-782-2396
  • Fax: 818-783-2467
Mailing address:
  • Phone: 818-783-2396
  • Fax: 818-783-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number10102
License Number StateCA

VIII. Authorized Official

Name: MR. BRET JOSEPH BACCIOCCO
Title or Position: CEO CLINICAL DIRECTOR
Credential:
Phone: 818-783-2396