Provider Demographics
NPI:1013188515
Name:SHIRATORI, TAKAKO (PT)
Entity Type:Individual
Prefix:MS
First Name:TAKAKO
Middle Name:
Last Name:SHIRATORI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 COMPASS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8043
Mailing Address - Country:US
Mailing Address - Phone:847-729-6220
Mailing Address - Fax:947-729-1116
Practice Address - Street 1:10700 MERIDIAN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9008
Practice Address - Country:US
Practice Address - Phone:206-860-2210
Practice Address - Fax:206-860-2296
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700162452251P0200X
WAPT60813965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics