=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841591856
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY YOSHINO NAKANISHI DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2010
-----------------------------------------------------
Last Update Date | 11/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1214 S ALTA VISTA AVE APT F
-----------------------------------------------------
City | MONROVIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91016-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-994-5826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1214 S ALTA VISTA AVE APT F
-----------------------------------------------------
City | MONROVIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91016-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-994-5826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 36776
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------