Individual
TAKEO ICHIYANAGI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
6 YEARLING CT, IRMO, SC 29063-2939
(803) 556-1089
Mailing address
6 YEARLING CT, IRMO, SC 29063-2939
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
SC
Other
Enumeration date
07/17/2014
Last updated
07/17/2014
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