MEDICARE: MR. YASUO KAMIBAYASHI P.T.

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	6084	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10768430	OTHER	NY	CAQH NO.
2	Q15C23	OTHER	NY	EMPIRE BCBS PROV. NO.

General Provider Information

NPI Number	:	1356398515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YASUO KAMIBAYASHI P.T.

Provider Business Mailing Address
First Line	:	304 OAK COVE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7516
Country	:	US
Telephone Number	:	845-649-6574
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 OAK COVE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7516
Country	:	US
Telephone Number	:	845-649-6574
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	01/07/2022

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