Provider Demographics
NPI:1649942673
Name:YAMAMOTO, KEVIN AOCHI (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:AOCHI
Last Name:YAMAMOTO
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 1:139 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2102
Mailing Address - Country:US
Mailing Address - Phone:914-753-4767
Mailing Address - Fax:212-753-4076
Practice Address - Street 1:594 BROADWAY RM 1207
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3289
Practice Address - Country:US
Practice Address - Phone:212-343-1500
Practice Address - Fax:212-343-1594
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047592-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty