Provider Demographics
NPI:1407002470
Name:KAJIWARA, TOMOMI (ATC, CSCS, NASM-PES)
Entity type:Individual
Prefix:
First Name:TOMOMI
Middle Name:
Last Name:KAJIWARA
Suffix:
Gender:M
Credentials:ATC, CSCS, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 S 68TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3636
Mailing Address - Country:US
Mailing Address - Phone:323-632-6001
Mailing Address - Fax:
Practice Address - Street 1:6001 DODGE ST # FH024
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68182-2000
Practice Address - Country:US
Practice Address - Phone:402-554-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer