Provider Demographics
NPI:1891185740
Name:MORI, YASUHO (ATC)
Entity Type:Individual
Prefix:
First Name:YASUHO
Middle Name:
Last Name:MORI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E 40TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1723
Mailing Address - Country:US
Mailing Address - Phone:212-682-0033
Mailing Address - Fax:866-680-3849
Practice Address - Street 1:124 E 40TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1723
Practice Address - Country:US
Practice Address - Phone:212-682-0033
Practice Address - Fax:866-680-3849
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0028232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer