Provider Demographics
NPI:1043485592
Name:OKAMOTO, KOJI (MPT)
Entity type:Individual
Prefix:
First Name:KOJI
Middle Name:
Last Name:OKAMOTO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21960 MCCLELLAN RD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4058
Mailing Address - Country:US
Mailing Address - Phone:650-271-5207
Mailing Address - Fax:
Practice Address - Street 1:21960 MCCLELLAN RD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4058
Practice Address - Country:US
Practice Address - Phone:502-715-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048421225100000X
OHPT 012068225100000X
CA34646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist