Provider Demographics
NPI:1225865603
Name:NAKATA, SKYLAR KIMI (DPT)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:KIMI
Last Name:NAKATA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 NE COLUMBIA BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-1930
Mailing Address - Country:US
Mailing Address - Phone:503-895-1320
Mailing Address - Fax:
Practice Address - Street 1:2205 NE COLUMBIA BLVD STE E
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-1930
Practice Address - Country:US
Practice Address - Phone:503-895-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR654602251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics