MEDICARE: TARA NAOMI OYASATO DPT

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	2251X0800X	Orthopedic Physical Therapist	4656	NV

General Provider Information

NPI Number	:	1770254906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA NAOMI OYASATO DPT

Provider Business Mailing Address
First Line	:	8765 STELLA NOVA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7240
Country	:	US
Telephone Number	:	808-271-7633
Fax Number	:

Provider Business Practice Location Address
First Line	:	6040 S RAINBOW BLVD STE B1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2542
Country	:	US
Telephone Number	:	702-876-9737
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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