Provider Demographics
NPI:1225863772
Name:TAMURA, KOTARO (DPT)
Entity type:Individual
Prefix:
First Name:KOTARO
Middle Name:
Last Name:TAMURA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 FIELDCREST DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-3531
Mailing Address - Country:US
Mailing Address - Phone:201-625-3017
Mailing Address - Fax:
Practice Address - Street 1:3754 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-2233
Practice Address - Country:US
Practice Address - Phone:412-854-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist