Provider Demographics
NPI:1881147957
Name:TSUKAHARA, MINAKO (ATC)
Entity type:Individual
Prefix:
First Name:MINAKO
Middle Name:
Last Name:TSUKAHARA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3031
Mailing Address - Country:US
Mailing Address - Phone:808-733-8465
Mailing Address - Fax:808-733-8467
Practice Address - Street 1:2526 10TH AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3031
Practice Address - Country:US
Practice Address - Phone:808-733-8465
Practice Address - Fax:808-733-8467
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT - 362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
120002042OtherNATIONAL ATHLETIC TRAINERS ASSOCIATION
HIAT - 36OtherATHLETIC TRAINER