Provider Demographics
NPI:1932343704
Name:RICO, AKEMI TANISAKI (DPT)
Entity Type:Individual
Prefix:MS
First Name:AKEMI
Middle Name:TANISAKI
Last Name:RICO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11818 GATEWAY BLVD
Mailing Address - Street 2:#5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2756
Mailing Address - Country:US
Mailing Address - Phone:310-980-0273
Mailing Address - Fax:
Practice Address - Street 1:5486 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4218
Practice Address - Country:US
Practice Address - Phone:323-954-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist