Provider Demographics
NPI:1194227009
Name:MIYAGAWA, SAKIKO
Entity type:Individual
Prefix:
First Name:SAKIKO
Middle Name:
Last Name:MIYAGAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25236 BIGELOW RD APT 2
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6935
Mailing Address - Country:US
Mailing Address - Phone:310-704-2561
Mailing Address - Fax:
Practice Address - Street 1:25236 BIGELOW RD APT 2
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6935
Practice Address - Country:US
Practice Address - Phone:310-704-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist