Provider Demographics
NPI:1912617440
Name:NAKAGAWA, TAKUTO (DPT)
Entity Type:Individual
Prefix:
First Name:TAKUTO
Middle Name:
Last Name:NAKAGAWA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 N VALLEY MILLS DR STE B
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2585
Mailing Address - Country:US
Mailing Address - Phone:254-300-7123
Mailing Address - Fax:254-294-5999
Practice Address - Street 1:2098 N VALLEY MILLS DR STE B
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2585
Practice Address - Country:US
Practice Address - Phone:254-300-7123
Practice Address - Fax:254-294-5999
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1343346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist