MEDICARE: MR. TADAHIRO KATORI ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1992811087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TADAHIRO KATORI ATC

Provider Business Mailing Address
First Line	:	4065 129TH PL SE APT 5
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-5832
Country	:	US
Telephone Number	:	425-746-3582
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 228TH AVE NE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7209
Country	:	US
Telephone Number	:	425-681-8627
Fax Number	:

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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