Provider Demographics
NPI:1386061810
Name:ISSHIKI, FUMIAKI
Entity type:Individual
Prefix:
First Name:FUMIAKI
Middle Name:
Last Name:ISSHIKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FUMIAKI
Other - Middle Name:
Other - Last Name:ISSHIKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:6771 WESTMINSTER BLVD
Mailing Address - Street 2:STE I
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8066
Mailing Address - Country:US
Mailing Address - Phone:562-598-5500
Mailing Address - Fax:562-598-5550
Practice Address - Street 1:6771 WESTMINSTER BLVD STE I
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-8066
Practice Address - Country:US
Practice Address - Phone:412-961-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410422251G0304X, 2251N0400X, 2251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty