Provider Demographics
NPI:1811248016
Name:OHARA, DENNIS MASAYUKI (PT)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MASAYUKI
Last Name:OHARA
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 1:833 MORTON WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8811
Mailing Address - Country:US
Mailing Address - Phone:916-792-3681
Mailing Address - Fax:
Practice Address - Street 1:833 MORTON WAY
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8811
Practice Address - Country:US
Practice Address - Phone:916-792-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist