Provider Demographics
NPI:1851653679
Name:NAKAYAMA, YUSUKE (ATC)
Entity Type:Individual
Prefix:
First Name:YUSUKE
Middle Name:
Last Name:NAKAYAMA
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 1:3035 STATEN AVE
Mailing Address - Street 2:APT. 12
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3796
Mailing Address - Country:US
Mailing Address - Phone:479-799-0012
Mailing Address - Fax:
Practice Address - Street 1:3035 STATEN AVE
Practice Address - Street 2:APT. 12
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3796
Practice Address - Country:US
Practice Address - Phone:479-799-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer