Individual
KOUSAKU JESSE OHTAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
325 MAINE ST, LAWRENCE, KS 66044-1360
(785) 505-2712
Mailing address
325 MAINE ST, LAWRENCE, KS 66044-1360
(785) 505-2712
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
LPT-31859
AZ
Other
Enumeration date
06/29/2024
Last updated
06/29/2024
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