Individual
OLIVIA TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9201 UNIVERSITY CITY BLVD, CHARLOTTE, NC 28223-0001
(704) 687-0431
Mailing address
2838 BIVINS ST, DAVIDSON, NC 28036-7615
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
5971
NC
Other
Enumeration date
12/19/2024
Last updated
12/19/2024
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