Provider Demographics
NPI:1477624484
Name:YAMADA SOTO, JANET (PT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:YAMADA SOTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:SOTO
Other - Last Name:MUKAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2041 BANCROFT WAY
Mailing Address - Street 2:STE 301
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1443
Mailing Address - Country:US
Mailing Address - Phone:510-549-2225
Mailing Address - Fax:510-549-0741
Practice Address - Street 1:2041 BANCROFT WAY
Practice Address - Street 2:STE 301
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1443
Practice Address - Country:US
Practice Address - Phone:510-549-2225
Practice Address - Fax:510-549-0741
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI382ZOtherMEDICARE PTAN
R27127Medicare UPIN