Provider Demographics
NPI:1316996747
Name:BUSSELL, ROBERT R X (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:BUSSELL
Suffix:X
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 SUTTER CREST WEST
Mailing Address - Street 2:
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685
Mailing Address - Country:US
Mailing Address - Phone:209-267-5301
Mailing Address - Fax:
Practice Address - Street 1:813 COURT STREET
Practice Address - Street 2:STE 2
Practice Address - City:JACKON
Practice Address - State:CA
Practice Address - Zip Code:95642
Practice Address - Country:US
Practice Address - Phone:209-223-3250
Practice Address - Fax:209-223-2517
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist