Active NPI
Renee Fomusa, DPT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1063872612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 42729
- Practice address
- 8933 Activity Rd
San Diego, CA 92126-4427 - Phone
- (858) 653-6085
- NPI assigned
- Feb 24, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 42729 | CA | Primary |
| Physical Therapist | 225100000X | 070.019297 | IL |
Addresses
Primary practice location
8933 Activity Rd
San Diego, CA 92126-4427
Mailing address
8933 Activity Rd
San Diego, CA 92126-4427
Phone (858) 653-6085
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.019297 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456272000000",
"number": "1063872612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8933 ACTIVITY RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921264427",
"telephone_number": "858-653-6085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8933 ACTIVITY RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921264427",
"telephone_number": "858-653-6085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOMUSA",
"first_name": "RENEE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-24",
"last_updated": "2016-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "42729",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.019297",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.