Provider Demographics
NPI:1508094129
Name:FUSSELL, CHRISTOPHER N (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:N
Last Name:FUSSELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10343 SIEGEN LN
Mailing Address - Street 2:3A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4979
Mailing Address - Country:US
Mailing Address - Phone:225-767-4440
Mailing Address - Fax:225-767-4441
Practice Address - Street 1:10343 SIEGEN LN
Practice Address - Street 2:3A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-4979
Practice Address - Country:US
Practice Address - Phone:225-767-4440
Practice Address - Fax:225-767-4441
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07627261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy