Provider Demographics
NPI:1245761998
Name:TSUKUSHI, NOEMILYN BURLAZA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:NOEMILYN
Middle Name:BURLAZA
Last Name:TSUKUSHI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3658 FARM HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-1231
Mailing Address - Country:US
Mailing Address - Phone:650-346-4693
Mailing Address - Fax:
Practice Address - Street 1:3658 FARM HILL BLVD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-1231
Practice Address - Country:US
Practice Address - Phone:650-346-4693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT1701172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT1701OtherAPTA