=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649667320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD FUJIYOSHI PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2015
-----------------------------------------------------
Last Update Date | 04/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 BORST AVE
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98531-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-807-0577
-----------------------------------------------------
Fax | 360-807-0574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1338
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98531-0735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-807-0577
-----------------------------------------------------
Fax | 360-807-0574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 60548803
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------