Provider Demographics
NPI:1407302144
Name:PHEAP, ASUKA MOROOKA (MA, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ASUKA
Middle Name:MOROOKA
Last Name:PHEAP
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:ASUKA
Other - Middle Name:
Other - Last Name:MOROOKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:9202 WHITE WATER LANE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219
Mailing Address - Country:US
Mailing Address - Phone:530-720-7576
Mailing Address - Fax:
Practice Address - Street 1:5151 PACIFIC AVENUE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-954-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer