Provider Demographics
NPI:1215591508
Name:YANAGISAWA, CHEYNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHEYNE
Middle Name:
Last Name:YANAGISAWA
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 1:10431 COMMERCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-0110
Mailing Address - Country:US
Mailing Address - Phone:909-735-7654
Mailing Address - Fax:
Practice Address - Street 1:10431 COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-0110
Practice Address - Country:US
Practice Address - Phone:909-735-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2917332251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics