Provider Demographics
NPI:1235809047
Name:NAKAGAWA, CHAD ISAMU (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ISAMU
Last Name:NAKAGAWA
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8778 SPECTRUM CENTER BLVD APT 411
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-5040
Mailing Address - Country:US
Mailing Address - Phone:714-393-5195
Mailing Address - Fax:
Practice Address - Street 1:2719 LOKER AVE W
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6678
Practice Address - Country:US
Practice Address - Phone:760-918-9200
Practice Address - Fax:760-918-9203
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300745OtherCA PT BOARD