Provider Demographics
NPI:1346432663
Name:PELUSO, HEATHEROSE (PT)
Entity Type:Individual
Prefix:
First Name:HEATHEROSE
Middle Name:
Last Name:PELUSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BURK ST
Mailing Address - Street 2:#101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3514
Mailing Address - Country:US
Mailing Address - Phone:510-847-6727
Mailing Address - Fax:510-272-0545
Practice Address - Street 1:2241 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3415
Practice Address - Country:US
Practice Address - Phone:415-833-7836
Practice Address - Fax:415-833-4877
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist