Provider Demographics
NPI:1497814339
Name:YAMASHITA, BRENTON (PT)
Entity Type:Individual
Prefix:
First Name:BRENTON
Middle Name:
Last Name:YAMASHITA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 N 1ST ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5449
Mailing Address - Country:US
Mailing Address - Phone:559-438-0355
Mailing Address - Fax:559-438-0359
Practice Address - Street 1:6049 N 1ST ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5449
Practice Address - Country:US
Practice Address - Phone:559-438-0355
Practice Address - Fax:559-438-0359
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ26802ZMedicare PIN