Provider Demographics
NPI:1962700302
Name:FUSION ARTS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:FUSION ARTS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-788-2544
Mailing Address - Street 1:16430 VENTURA BLVD
Mailing Address - Street 2:STE 108
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2115
Mailing Address - Country:US
Mailing Address - Phone:818-788-2544
Mailing Address - Fax:818-788-8303
Practice Address - Street 1:16430 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2132
Practice Address - Country:US
Practice Address - Phone:818-788-2544
Practice Address - Fax:818-788-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT149052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT14905OtherPT LICENSE