Provider Demographics
NPI:1720064355
Name:TUSSY, WILLIAM HENRY (RPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:TUSSY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2734
Mailing Address - Country:US
Mailing Address - Phone:760-720-9774
Mailing Address - Fax:760-268-0704
Practice Address - Street 1:6120 PASEO DEL NORTE
Practice Address - Street 2:SUITE D-1
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1150
Practice Address - Country:US
Practice Address - Phone:760-268-0702
Practice Address - Fax:760-268-0704
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14189225100000X, 2251X0800X
2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT14189AMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
CAW19323Medicare ID - Type UnspecifiedGROUP NUMBER