Provider Demographics
NPI:1386675700
Name:NISHIMOTO, DAVID TETSUO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:TETSUO
Last Name:NISHIMOTO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
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Other - First Name:
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Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:SUITE #2640
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-788-5540
Mailing Address - Fax:415-788-5970
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE #2640
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-788-5540
Practice Address - Fax:415-788-5970
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT 7193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA#00PT71930Medicare ID - Type Unspecified