Provider Demographics
NPI:1902860844
Name:MUKAI, PAUL T (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:T
Last Name:MUKAI
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:PO BOX 12721
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-0721
Mailing Address - Country:US
Mailing Address - Phone:415-515-5884
Mailing Address - Fax:
Practice Address - Street 1:12119 SE STEVENS CT
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-2620
Practice Address - Country:US
Practice Address - Phone:503-353-1278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9311225100000X
CAPT25621225100000X
OR4747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist