MEDICARE: MR. KYLE MINORU YAMASHIRO 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	PT17746	CA

General Provider Information

NPI Number	:	1932207974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KYLE MINORU YAMASHIRO P.T.

Provider Business Mailing Address
First Line	:	9500 MICRON AVE
Second Line	:	SUITE 106
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2617
Country	:	US
Telephone Number	:	916-362-7962
Fax Number	:	916-362-7963

Provider Business Practice Location Address
First Line	:	9500 MICRON AVE
Second Line	:	SUITE 106
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2617
Country	:	US
Telephone Number	:	916-362-7962
Fax Number	:	916-362-7963

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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