Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT295930 | CA |
NPI | 1508338245 |
---|---|
Provider Name | Joshua Tatsuno |
First Address | San Jose, CA 95127-1151 |
Second Address | San Jose, CA 95118-3825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2018 |
Last Update Date | 19/12/2018 |