MEDICARE: JASON TANAKA PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	39899	CA

General Provider Information

NPI Number	:	1265854137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON TANAKA PT, DPT

Provider Business Mailing Address
First Line	:	1234 N LA BREA AVE
Second Line	:	#114
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90038-1179
Country	:	US
Telephone Number	:	213-841-1946
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 N LA BREA AVE
Second Line	:	#114
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90038-1179
Country	:	US
Telephone Number	:	213-841-1946
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	06/03/2019

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