Provider Demographics
NPI:1861476723
Name:TAKEHARA, JAMES M (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:TAKEHARA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5313
Mailing Address - Country:US
Mailing Address - Phone:831-375-1885
Mailing Address - Fax:831-375-7436
Practice Address - Street 1:2000 GARDEN RD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5313
Practice Address - Country:US
Practice Address - Phone:831-375-1885
Practice Address - Fax:831-375-7436
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAO848ZMedicare PIN