Provider Demographics
NPI:1306955943
Name:HUSSON-VAN NORMAN, ROXANNE (RPT)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:HUSSON-VAN NORMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8344 CLAIREMONT MESA BLVD 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1327
Mailing Address - Country:US
Mailing Address - Phone:858-565-6910
Mailing Address - Fax:858-565-6911
Practice Address - Street 1:8344 CLAIREMONT MESA BLVD 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1327
Practice Address - Country:US
Practice Address - Phone:858-565-6910
Practice Address - Fax:858-565-6911
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18841225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT18841AMedicare ID - Type Unspecified