Individual
KOKI KAWAGUCHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
2497 HARLANSBURG RD, NEW CASTLE, PA 16101-9723
(724) 658-8940
Mailing address
214 E WATER ST, SLIPPERY ROCK, PA 16057-1150
(724) 290-5647
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT007484
PA
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/25/2019
Last updated
08/05/2021
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