Provider Demographics
NPI:1154807659
Name:ONISHI, ERIC (LAT, ATC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ONISHI
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5847 NE 75TH ST # A226
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8105
Mailing Address - Country:US
Mailing Address - Phone:425-502-1840
Mailing Address - Fax:
Practice Address - Street 1:3870 MONTLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0007
Practice Address - Country:US
Practice Address - Phone:206-543-2239
Practice Address - Fax:206-685-3521
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1609815992255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty