Provider Demographics
NPI:1598739310
Name:KONDO, AKIRA (ATC)
Entity Type:Individual
Prefix:MR
First Name:AKIRA
Middle Name:
Last Name:KONDO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PIMA COMMUNITY COLLEGE
Mailing Address - Street 2:2202 W ANKLAM RD
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85709-0285
Mailing Address - Country:US
Mailing Address - Phone:520-206-6012
Mailing Address - Fax:520-206-6799
Practice Address - Street 1:PIMA COMMUNITY COLLEGE
Practice Address - Street 2:2202 W ANKLAM RD
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85709-0285
Practice Address - Country:US
Practice Address - Phone:520-206-6012
Practice Address - Fax:520-206-6799
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA000522255A2300X
AZ13312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer