Provider Demographics
NPI:1437558723
Name:MIZUKAMI, HIKARI DANIEL (DPT)
Entity Type:Individual
Prefix:
First Name:HIKARI
Middle Name:DANIEL
Last Name:MIZUKAMI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:MIZUKAMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:17800 TALBOT RD S
Practice Address - Street 2:SUITE D
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5740
Practice Address - Country:US
Practice Address - Phone:425-277-9096
Practice Address - Fax:425-277-1206
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60484211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8934589Medicare UPIN