Provider Demographics
NPI:1356357065
Name:KAMIMOTO, STANLEY YASHIO (MPT)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:YASHIO
Last Name:KAMIMOTO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8402 CENTENNIAL PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4793
Mailing Address - Country:US
Mailing Address - Phone:702-294-7499
Mailing Address - Fax:702-294-7494
Practice Address - Street 1:3820 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2454
Practice Address - Country:US
Practice Address - Phone:702-731-0831
Practice Address - Fax:702-737-9697
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist