Provider Demographics
NPI:1306007208
Name:SHONO, AYAKO NIVA (BS, MPT)
Entity Type:Individual
Prefix:MS
First Name:AYAKO
Middle Name:NIVA
Last Name:SHONO
Suffix:
Gender:F
Credentials:BS, MPT
Other - Prefix:MRS
Other - First Name:AYAKO
Other - Middle Name:
Other - Last Name:KRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MPT
Mailing Address - Street 1:1401 AVOCADO AVE STE 808
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8707
Mailing Address - Country:US
Mailing Address - Phone:949-706-1001
Mailing Address - Fax:949-706-1002
Practice Address - Street 1:1401 AVOCADO AVE STE 808
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8707
Practice Address - Country:US
Practice Address - Phone:949-706-1001
Practice Address - Fax:949-706-1002
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14876225100000X
CO9236225100000X
CA14876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist