Provider Demographics
NPI:1699703603
Name:TUSSY PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:TUSSY PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:TUSSY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-268-0702
Mailing Address - Street 1:6120 PASEO DEL NORTE
Mailing Address - Street 2:D-1
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1150
Mailing Address - Country:US
Mailing Address - Phone:760-268-0702
Mailing Address - Fax:760-268-0704
Practice Address - Street 1:6120 PASEO DEL NORTE
Practice Address - Street 2:D-1
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1150
Practice Address - Country:US
Practice Address - Phone:760-268-0702
Practice Address - Fax:760-268-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14189174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19323Medicare ID - Type UnspecifiedGROUP ID