Provider Demographics
NPI:1306152392
Name:OKAZAKI, GALEN M (PT)
Entity type:Individual
Prefix:
First Name:GALEN
Middle Name:M
Last Name:OKAZAKI
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 1:1748 SINALOA RD
Mailing Address - Street 2:#258
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3071
Mailing Address - Country:US
Mailing Address - Phone:818-730-2994
Mailing Address - Fax:
Practice Address - Street 1:1748 SINALOA RD
Practice Address - Street 2:#258
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3071
Practice Address - Country:US
Practice Address - Phone:818-730-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT28515OtherPT LICENSE