Provider Demographics
NPI:1720076425
Name:TAKAO, SCOTT HIROSHI (ATC; CSCS)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:HIROSHI
Last Name:TAKAO
Suffix:
Gender:M
Credentials:ATC; CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 E BIG VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1938
Mailing Address - Country:US
Mailing Address - Phone:520-825-7963
Mailing Address - Fax:
Practice Address - Street 1:2500 E AJO WAY
Practice Address - Street 2:CHICAGO WHITE SOX
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6218
Practice Address - Country:US
Practice Address - Phone:520-434-1263
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00382255A2300X
NC08442255A2300X
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer