Provider Demographics
NPI:1194920256
Name:HASEGAWA, MASATO (PT)
Entity type:Individual
Prefix:MR
First Name:MASATO
Middle Name:
Last Name:HASEGAWA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1-16-18 MIZUTANI-HIGASHI
Mailing Address - Street 2:
Mailing Address - City:FUJIMI-CITY
Mailing Address - State:SAITAMA
Mailing Address - Zip Code:3540013
Mailing Address - Country:JP
Mailing Address - Phone:8149-251-3249
Mailing Address - Fax:8149-251-3249
Practice Address - Street 1:1-16-18 MIZUTANI-HIGASHI
Practice Address - Street 2:
Practice Address - City:FUJIMI-CITY
Practice Address - State:SAITAMA
Practice Address - Zip Code:3540013
Practice Address - Country:JP
Practice Address - Phone:8149-251-3249
Practice Address - Fax:8149-251-3249
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist