Provider Demographics
NPI:1437211919
Name:FUSION PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:FUSION PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BACCIOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-783-2396
Mailing Address - Street 1:1560 NEWBURY RD STE 1
Mailing Address - Street 2:#253
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3448
Mailing Address - Country:US
Mailing Address - Phone:818-783-2396
Mailing Address - Fax:818-783-2467
Practice Address - Street 1:5000 VAN NUYS BLVD STE 314
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1852
Practice Address - Country:US
Practice Address - Phone:818-782-2396
Practice Address - Fax:818-783-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CA10102261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty