Healthcare Provider Details

I. General information

NPI: 1649678558
Provider Name (Legal Business Name): NAOHIKO SHIMADA P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NAO SHIMADA P.T.

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20404 ANZA AVE APT 24
TORRANCE CA
90503-2343
US

IV. Provider business mailing address

20404 ANZA AVE APT 24
TORRANCE CA
90503-2343
US

V. Phone/Fax

Practice location:
  • Phone: 424-271-2288
  • Fax:
Mailing address:
  • Phone: 424-271-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT28134
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT28134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: