Provider Demographics
NPI:1770254906
Name:OYASATO, TARA NAOMI (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:NAOMI
Last Name:OYASATO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 STELLA NOVA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7240
Mailing Address - Country:US
Mailing Address - Phone:808-271-7633
Mailing Address - Fax:
Practice Address - Street 1:6040 S RAINBOW BLVD STE B1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2542
Practice Address - Country:US
Practice Address - Phone:702-876-9737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV46562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic