Provider Demographics
NPI:1346742806
Name:SHIMOZAKI, YOHEI (ATC)
Entity Type:Individual
Prefix:
First Name:YOHEI
Middle Name:
Last Name:SHIMOZAKI
Suffix:
Gender:M
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:PO BOX 2082
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71656-2082
Mailing Address - Country:US
Mailing Address - Phone:405-219-1206
Mailing Address - Fax:
Practice Address - Street 1:605 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71656
Practice Address - Country:US
Practice Address - Phone:870-460-1658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000306162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer