Provider Demographics
NPI:1013129485
Name:MITA, HARRY HIROSHI (PT)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:HIROSHI
Last Name:MITA
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 1:2216 E PETUNIA ST
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4644
Mailing Address - Country:US
Mailing Address - Phone:626-852-0844
Mailing Address - Fax:
Practice Address - Street 1:420 E 3RD ST
Practice Address - Street 2:#703
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1644
Practice Address - Country:US
Practice Address - Phone:213-687-3278
Practice Address - Fax:213-680-2010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist