Provider Demographics
NPI:1932744364
Name:NAGAI, TAKASHI (PHD, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:TAKASHI
Middle Name:
Last Name:NAGAI
Suffix:
Gender:M
Credentials:PHD, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 ALAN LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-5677
Mailing Address - Country:US
Mailing Address - Phone:412-398-2874
Mailing Address - Fax:
Practice Address - Street 1:4718 ALAN LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-5677
Practice Address - Country:US
Practice Address - Phone:412-398-2874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0066922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer