Provider Demographics
NPI:1730307083
Name:TASHIRO, TRAE (MED, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:TRAE
Middle Name:
Last Name:TASHIRO
Suffix:
Gender:M
Credentials:MED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 N BORG LANE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:86716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 NATIONAL CHAMPIONSHIP DRIVE
Practice Address - Street 2:MCKALE CENTER N108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721
Practice Address - Country:US
Practice Address - Phone:520-621-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer