Provider Demographics
NPI:1740455575
Name:TAKASHIMA, KAREN L (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:TAKASHIMA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 N HIGH ST
Mailing Address - Street 2:SUITE 203-D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3247
Mailing Address - Country:US
Mailing Address - Phone:614-314-5773
Mailing Address - Fax:614-636-4582
Practice Address - Street 1:4041 N HIGH ST
Practice Address - Street 2:SUITE 203-D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3247
Practice Address - Country:US
Practice Address - Phone:614-314-5773
Practice Address - Fax:614-636-4582
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 22 5100000X174400000X
OHOHPT-0890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH270190Medicare PIN
OH20-1747908OtherEIN NUMBER