MEDICARE: HAJIME TAKASHIMA MED, ATC, LAT, CSCS

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	2255A2300X	Athletic Trainer	AT4648	TX

General Provider Information

NPI Number	:	1558717678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAJIME TAKASHIMA MED, ATC, LAT, CSCS

Provider Business Mailing Address
First Line	:	2121 EL PASEO ST
Second Line	:	1102
City	:	HOUSTON
State	:	TX
Zip	:	77054-3246
Country	:	US
Telephone Number	:	713-204-9214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 EL PASEO ST
Second Line	:	1102
City	:	HOUSTON
State	:	TX
Zip	:	77054-3246
Country	:	US
Telephone Number	:	713-204-9214
Fax Number	:

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

Provider Enumeration Date	:	05/07/2016
Last Update Date	:	05/07/2016

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