Provider Demographics
NPI:1134125883
Name:CASUGA, NISSA L (DPT)
Entity Type:Individual
Prefix:
First Name:NISSA
Middle Name:L
Last Name:CASUGA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 BROCKTON AVE
Mailing Address - Street 2:STE 212
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3808
Mailing Address - Country:US
Mailing Address - Phone:951-774-4611
Mailing Address - Fax:951-276-3597
Practice Address - Street 1:6860 BROCKTON AVE
Practice Address - Street 2:STE 7
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3821
Practice Address - Country:US
Practice Address - Phone:951-369-0860
Practice Address - Fax:951-774-4623
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT290881Medicare PIN