Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 33977 | CA |
NPI | 1003164344 |
---|---|
Provider Name | Shintaro Tatebe |
First Address | San Francisco, CA 94102-5714 |
Second Address | San Francisco, CA 94143-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2012 |
Last Update Date | 16/08/2012 |