Provider Demographics
NPI:1639561251
Name:TSUTAI, SAWAKO (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SAWAKO
Middle Name:
Last Name:TSUTAI
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DONAGHEY AVE
Mailing Address - Street 2:FARRIS CENTER 104
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72035-5001
Mailing Address - Country:US
Mailing Address - Phone:501-450-5723
Mailing Address - Fax:
Practice Address - Street 1:201 DONAGHEY AVE
Practice Address - Street 2:FARRIS CENTER 104
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72035-5001
Practice Address - Country:US
Practice Address - Phone:501-450-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 6032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer