Healthcare Provider Details

I. General information

NPI: 1508338245
Provider Name (Legal Business Name): JOSHUA TATSUNO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 BLOSSOM HILL RD STE 33
SAN JOSE CA
95118-3825
US

IV. Provider business mailing address

993 SELBY LN
SAN JOSE CA
95127-1151
US

V. Phone/Fax

Practice location:
  • Phone: 408-784-7167
  • Fax:
Mailing address:
  • Phone: 408-493-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT295930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: