Provider Demographics
NPI:1053359679
Name:FUSSO, DENISE (BS)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:FUSSO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:DEN
Other - Middle Name:
Other - Last Name:FUSSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:12515 NE 5TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685
Mailing Address - Country:US
Mailing Address - Phone:360-573-2825
Mailing Address - Fax:
Practice Address - Street 1:805 BROADWAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660
Practice Address - Country:US
Practice Address - Phone:360-823-0138
Practice Address - Fax:360-823-0141
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist