Provider Demographics
NPI:1295562957
Name:HIROTA, TATSUNARI (PT DPT)
Entity type:Individual
Prefix:
First Name:TATSUNARI
Middle Name:
Last Name:HIROTA
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3501
Mailing Address - Country:US
Mailing Address - Phone:619-422-0404
Mailing Address - Fax:619-422-4153
Practice Address - Street 1:311 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3501
Practice Address - Country:US
Practice Address - Phone:619-422-0404
Practice Address - Fax:619-422-4153
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist