Provider Demographics
NPI:1700363132
Name:UCHIDA, TAKAHIRO (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:TAKAHIRO
Middle Name:
Last Name:UCHIDA
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 LOWER CAMPUS RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2352
Mailing Address - Country:US
Mailing Address - Phone:636-627-1172
Mailing Address - Fax:
Practice Address - Street 1:1337 LOWER CAMPUS RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2352
Practice Address - Country:US
Practice Address - Phone:636-627-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT3142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer