Provider Demographics
NPI:1679145197
Name:MITSUYAMA, YOSHI (ATC)
Entity Type:Individual
Prefix:
First Name:YOSHI
Middle Name:
Last Name:MITSUYAMA
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 1:9101 HARLAN ST UNIT 225
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2926
Mailing Address - Country:US
Mailing Address - Phone:970-584-4075
Mailing Address - Fax:
Practice Address - Street 1:9101 HARLAN ST UNIT 225
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2926
Practice Address - Country:US
Practice Address - Phone:970-584-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00018302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer