Healthcare Provider Details

I. General information

NPI: 1154807659
Provider Name (Legal Business Name): ERIC ONISHI LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 MONTLAKE BLVD
SEATTLE WA
98195-0007
US

IV. Provider business mailing address

5847 NE 75TH ST # A226
SEATTLE WA
98115-8105
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-2239
  • Fax: 206-685-3521
Mailing address:
  • Phone: 425-502-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA160981599
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: