Individual
TYE ICHIRO MASAKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11105 KNOTT AVE, SUITE A, CYPRESS, CA 90630-5137
(714) 893-7399
(714) 893-7389
Mailing address
11105 KNOTT AVE, SUITE A, CYPRESS, CA 90630-5137
(714) 893-7399
(714) 893-7389
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
AT5466
CA
Other
Enumeration date
08/09/2011
Last updated
08/09/2011
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