Provider Demographics
NPI:1225803729
Name:GOTO, SHIHO (ATC)
Entity Type:Individual
Prefix:
First Name:SHIHO
Middle Name:
Last Name:GOTO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MARTIAL AVE APT 8133
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6981
Mailing Address - Country:US
Mailing Address - Phone:919-724-3942
Mailing Address - Fax:
Practice Address - Street 1:110 E MARTIAL AVE APT 8133
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6981
Practice Address - Country:US
Practice Address - Phone:919-724-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer