Provider Demographics
NPI:1063483899
Name:FUSELIER, KIMBERLY KIRTON (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KIRTON
Last Name:FUSELIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18873 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4164
Mailing Address - Country:US
Mailing Address - Phone:714-559-0885
Mailing Address - Fax:714-982-5135
Practice Address - Street 1:18200 YORBA LINDA BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4056
Practice Address - Country:US
Practice Address - Phone:714-646-8070
Practice Address - Fax:714-982-5135
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist