MEDICARE: STANLEY YASHIO KAMIMOTO MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1729	NV

General Provider Information

NPI Number	:	1356357065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY YASHIO KAMIMOTO MPT

Provider Business Mailing Address
First Line	:	8402 CENTENNIAL PKWY STE 240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4793
Country	:	US
Telephone Number	:	702-294-7499
Fax Number	:	702-294-7494

Provider Business Practice Location Address
First Line	:	3820 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2454
Country	:	US
Telephone Number	:	702-731-0831
Fax Number	:	702-737-9697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	09/28/2021

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