Healthcare Provider Details

I. General information

NPI: 1124671821
Provider Name (Legal Business Name): FLETCHER JOHN ZUMBUSCH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHERRY AVE STE 250
SIGNAL HILL CA
90755-2041
US

IV. Provider business mailing address

5527 DUNROBIN AVE
LAKEWOOD CA
90713-1403
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-5159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1319306
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number296753
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number296753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: