Provider Demographics
NPI:1649840661
Name:NORIMOTO, DEREK TAISHI (PT, DPT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:TAISHI
Last Name:NORIMOTO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12353 EVENSONG DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3531
Mailing Address - Country:US
Mailing Address - Phone:310-892-9248
Mailing Address - Fax:
Practice Address - Street 1:253 N SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3114
Practice Address - Country:US
Practice Address - Phone:626-294-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist