MEDICARE: YOSHITAKA DAN KOYASU 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	PT26534	CA

General Provider Information

NPI Number	:	1588895270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOSHITAKA DAN KOYASU DPT

Provider Business Mailing Address
First Line	:	600 CENTRAL AVE STE C
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-2740
Country	:	US
Telephone Number	:	951-696-9353
Fax Number	:

Provider Business Practice Location Address
First Line	:	31764 CASINO DR STE 106A&B
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-2312
Country	:	US
Telephone Number	:	951-471-3300
Fax Number	:	951-471-3301

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

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	02/07/2023

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