Provider Demographics
NPI:1942239785
Name:TAKII, BRUCE I (PT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:I
Last Name:TAKII
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 1:337 S 10TH ST
Mailing Address - Street 2:STE G
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-3300
Mailing Address - Country:US
Mailing Address - Phone:661-763-4194
Mailing Address - Fax:661-763-5792
Practice Address - Street 1:337 S. 10TH ST. #G
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-3300
Practice Address - Country:US
Practice Address - Phone:661-763-4194
Practice Address - Fax:661-763-5792
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ90568ZMedicare ID - Type UnspecifiedWESTERN PROVIDER #
CAZZZ19077ZMedicare ID - Type UnspecifiedSOUTHCOAST PROV #
CA00PT60330Medicare UPIN