Provider Demographics
NPI:1427320365
Name:EZAKI, JOHN PHILIP (CMT,LMT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PHILIP
Last Name:EZAKI
Suffix:
Gender:M
Credentials:CMT,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LEHIGH PKWY E
Mailing Address - Street 2:10L
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3000
Mailing Address - Country:US
Mailing Address - Phone:610-434-1975
Mailing Address - Fax:
Practice Address - Street 1:1600 LEHIGH PKWY E
Practice Address - Street 2:10L
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3000
Practice Address - Country:US
Practice Address - Phone:610-434-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist