Provider Demographics
NPI:1396231387
Name:KAMIKURA, MOTOKI (ATC)
Entity Type:Individual
Prefix:MR
First Name:MOTOKI
Middle Name:
Last Name:KAMIKURA
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 1:208 EDGEMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2320
Mailing Address - Country:US
Mailing Address - Phone:719-587-7011
Mailing Address - Fax:
Practice Address - Street 1:208 EDGEMONT BLVD
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2320
Practice Address - Country:US
Practice Address - Phone:719-587-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00016192081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine