Provider Demographics
NPI:1962069765
Name:FUKUSHIMA, MASATO (DPT)
Entity type:Individual
Prefix:MR
First Name:MASATO
Middle Name:
Last Name:FUKUSHIMA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18414 DOTY AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4823
Mailing Address - Country:US
Mailing Address - Phone:310-765-0835
Mailing Address - Fax:
Practice Address - Street 1:2499 S WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5434
Practice Address - Country:US
Practice Address - Phone:310-638-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist