Provider Demographics
NPI:1265854137
Name:TANAKA, JASON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:TANAKA
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 1:1234 N LA BREA AVE
Mailing Address - Street 2:#114
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90038-1179
Mailing Address - Country:US
Mailing Address - Phone:213-841-1946
Mailing Address - Fax:
Practice Address - Street 1:1234 N LA BREA AVE
Practice Address - Street 2:#114
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90038-1179
Practice Address - Country:US
Practice Address - Phone:213-841-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist