Provider Demographics
NPI:1609439942
Name:KAMIYAMA PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:KAMIYAMA PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENTO
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMIYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-655-9029
Mailing Address - Street 1:1 ORIENT WAY STE F217
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1410 BROADWAY CONCOURSE LEVEL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:201-655-9029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAMIYAMA PHYSICAL THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty