Provider Demographics
NPI:1588651855
Name:FUKES, DIANNE M (PT)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:M
Last Name:FUKES
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 1:2001 SOLAR DR STE 150
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0680
Mailing Address - Country:US
Mailing Address - Phone:805-604-1924
Mailing Address - Fax:805-604-0176
Practice Address - Street 1:2001 SOLAR DR STE 150
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0680
Practice Address - Country:US
Practice Address - Phone:315-329-7400
Practice Address - Fax:315-329-7400
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297816225100000X
NY0250411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA5803Medicare ID - Type Unspecified