Provider Demographics
NPI:1447802749
Name:NAKAGI, RYOTA
Entity Type:Individual
Prefix:
First Name:RYOTA
Middle Name:
Last Name:NAKAGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 KEMPER ST
Mailing Address - Street 2:
Mailing Address - City:SCOOBA
Mailing Address - State:MS
Mailing Address - Zip Code:39358-7601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1512 KEMPER ST
Practice Address - Street 2:
Practice Address - City:SCOOBA
Practice Address - State:MS
Practice Address - Zip Code:39358-7601
Practice Address - Country:US
Practice Address - Phone:304-905-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer