Provider Demographics
NPI:1316271216
Name:KUSUNOSE, DIANE S (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:KUSUNOSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7937 CORTE DOMINGO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9533
Mailing Address - Country:US
Mailing Address - Phone:760-420-0378
Mailing Address - Fax:760-942-0645
Practice Address - Street 1:7937 CORTE DOMINGO
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-9533
Practice Address - Country:US
Practice Address - Phone:760-420-0378
Practice Address - Fax:760-942-0645
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist