Provider Demographics
NPI:1285709881
Name:NAKAE, JAMES CARL (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CARL
Last Name:NAKAE
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 1:5036 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2107
Mailing Address - Country:US
Mailing Address - Phone:310-540-9793
Mailing Address - Fax:310-540-9793
Practice Address - Street 1:5036 AVENUE B
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2107
Practice Address - Country:US
Practice Address - Phone:310-540-9793
Practice Address - Fax:310-540-9793
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT20065Medicare ID - Type UnspecifiedMEDICARE PROVIDER