Provider Demographics
NPI:1821344375
Name:NAKATA, KELSEY MAKOTO (DPT)
Entity Type:Individual
Prefix:MR
First Name:KELSEY
Middle Name:MAKOTO
Last Name:NAKATA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:980 CASS ST
Mailing Address - Street 2:STE A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4549
Mailing Address - Country:US
Mailing Address - Phone:310-474-5150
Mailing Address - Fax:310-474-4924
Practice Address - Street 1:980 CASS ST
Practice Address - Street 2:STE A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4549
Practice Address - Country:US
Practice Address - Phone:831-375-2466
Practice Address - Fax:831-375-0450
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA391602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic