MEDICARE: AKIRA REUBEN KATAGIRI LAT, ATC

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	146N00000X	Basic Emergency Medical Technician	724561	TX
2	2255A2300X	Athletic Trainer	AT7578	TX

General Provider Information

NPI Number	:	1912453101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKIRA REUBEN KATAGIRI LAT, ATC

Provider Business Mailing Address
First Line	:	302 GREEN MOUNTAIN LN APT 7208
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-5622
Country	:	US
Telephone Number	:	817-917-7567
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 GREEN MOUNTAIN LN APT 7208
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-5622
Country	:	US
Telephone Number	:	817-917-7567
Fax Number	:

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

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	01/11/2020

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