Provider Demographics
NPI:1811441777
Name:KOBAYASHI, SHUNTARO (ATC)
Entity type:Individual
Prefix:
First Name:SHUNTARO
Middle Name:
Last Name:KOBAYASHI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 TROON DR
Mailing Address - Street 2:APT 105
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5609
Mailing Address - Country:US
Mailing Address - Phone:870-273-5201
Mailing Address - Fax:
Practice Address - Street 1:1595 TROON DR
Practice Address - Street 2:APT 105
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5609
Practice Address - Country:US
Practice Address - Phone:870-273-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer