Provider Demographics
NPI:1932207974
Name:YAMASHIRO, KYLE MINORU (PT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:MINORU
Last Name:YAMASHIRO
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 1:9500 MICRON AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2617
Mailing Address - Country:US
Mailing Address - Phone:916-362-7962
Mailing Address - Fax:916-362-7963
Practice Address - Street 1:9500 MICRON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2617
Practice Address - Country:US
Practice Address - Phone:916-362-7962
Practice Address - Fax:916-362-7963
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT177460Medicare ID - Type Unspecified