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Individual
STACEY LU TAKESHITA
Active
Individual
STACEY LU TAKESHITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1303240
TX
225100000X
Physical Therapist
35267
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EK468Z
MEDICARE PTAN
CA
Enumeration date
02/23/2009
Last updated
01/28/2020
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