Provider Demographics
NPI:1669684254
Name:SAKAMOTO, ERIC R (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:SAKAMOTO
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:PO BOX 31188
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228
Mailing Address - Country:US
Mailing Address - Phone:360-733-0500
Mailing Address - Fax:360-671-3366
Practice Address - Street 1:1611 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-733-0500
Practice Address - Fax:360-671-3366
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8752SAOtherREGENCE HEALTHCARE INS
WA183767OtherLABOR & INDUSTRIES WC
8803343Medicare ID - Type Unspecified