Physiofusion Rehab Services, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

PHYSIOFUSION REHAB SERVICES, LLC

Practice address

9200 Milliken Ave Apt 8214
Rancho Cucamonga, CA 91730-8517

Phone

(909) 420-5752

NPI assigned

Feb 19, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patrice Watson, OTR/L

Title

Director of Operations

Phone

(909) 420-5752

Specialties & licenses 2

Addresses

Other names 1

• PhysioFusion Rehab Services, LLC Other name

Electronic endpoints 3

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Armand Watson, PTA

  • Physical Therapy Assistant
  • Rancho Cucamonga, CA
  • NPI 1063775575
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1265025258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 MILLIKEN AVE APT 8214",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917308517",
            "telephone_number": "909-420-5752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 MILLIKEN AVE APT 8214",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917308517",
            "telephone_number": "909-420-5752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIOFUSION REHAB SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-19",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "PATRICE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "909-420-5752",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "physiofusionrehab.net",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9200 Milliken Ave Apt 8214",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917308517",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "physiofusionrehab.net",
            "affiliation": "N",
            "endpointDescription": "Electronic Medical Record System",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "9200 Milliken Ave Apt 8214",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917308517",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "physiofusionrehab.net",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMR",
            "address_1": "9200 Milliken Ave Apt 8214",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917308517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "PhysioFusion Rehab Services, LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PhysioFusion Rehab Services, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Berlinda Phommalayhane
• Boonma Phommalayvane
• Jenny Phong, PHARMD, RPH
• Breanna Phua, RBT
• Wasien Arthur Phungkusol
• Amanda Picazo
• Anna Marie Pickett
• Yaricsa Picon Carrillo
• Rebecca Pierce
• Kena Deshon Pierre, REGISTERED NURSE

• Occupational Therapist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.