Basic Information
| Provider Information | |||||||||
| NPI: | 1649942673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAMAMOTO | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | AOCHI | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 E 57TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100222102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147534767 | ||||||||
| FaxNumber: | 2127534076 | ||||||||
| Practice Location | |||||||||
| Address1: | 594 BROADWAY RM 1207 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100123289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123431500 | ||||||||
| FaxNumber: | 2123431594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2021 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 047592-01 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.