Provider Demographics
NPI:1558032169
Name:FUKUI, BRYNN KAYLENE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BRYNN
Middle Name:KAYLENE
Last Name:FUKUI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7775 RIVER LANDING DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5785
Mailing Address - Country:US
Mailing Address - Phone:916-533-4602
Mailing Address - Fax:
Practice Address - Street 1:2424 ARDEN WAY STE 303
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2430
Practice Address - Country:US
Practice Address - Phone:916-977-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300930225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty