Provider Demographics
NPI:1962533513
Name:IJICHI, KYOKO (PT)
Entity type:Individual
Prefix:MS
First Name:KYOKO
Middle Name:
Last Name:IJICHI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W 25TH ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5561
Mailing Address - Country:US
Mailing Address - Phone:212-741-5544
Mailing Address - Fax:
Practice Address - Street 1:511 W 25TH ST
Practice Address - Street 2:SUITE 507
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5561
Practice Address - Country:US
Practice Address - Phone:212-741-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520067-1163W00000X
NY027038-1225100000X
NJ40QA01164900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No163W00000XNursing Service ProvidersRegistered Nurse