Healthcare Provider Details

I. General information

NPI: 1629753272
Provider Name (Legal Business Name): BREANNA URASAKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 LOMITA BLVD # B
TORRANCE CA
90505-5102
US

IV. Provider business mailing address

1930 MANHATTAN BEACH BLVD APT 219
REDONDO BEACH CA
90278-1200
US

V. Phone/Fax

Practice location:
  • Phone: 310-546-3461
  • Fax:
Mailing address:
  • Phone: 760-224-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT304138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: