Provider Demographics
NPI:1619106093
Name:ISHIBASHI, JOAN CHIAKI (LMT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:CHIAKI
Last Name:ISHIBASHI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17422 CLIFTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2212
Mailing Address - Country:US
Mailing Address - Phone:216-333-2722
Mailing Address - Fax:
Practice Address - Street 1:17422 CLIFTON BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-2212
Practice Address - Country:US
Practice Address - Phone:216-333-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13445225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist