Provider Demographics
NPI:1942745021
Name:MASAOKA, GARRETT
Entity Type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:
Last Name:MASAOKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 ROUTE 10
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96913-1337
Mailing Address - Country:US
Mailing Address - Phone:671-735-8000
Mailing Address - Fax:
Practice Address - Street 1:263 ROUTE 10
Practice Address - Street 2:
Practice Address - City:BARRIGADA
Practice Address - State:GU
Practice Address - Zip Code:96913-1337
Practice Address - Country:US
Practice Address - Phone:671-735-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPTA06225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant