Individual
DANIEL TAKATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1650 W ALABAMA AVE, RUSTON, LA 71270-3120
(773) 706-4540
Mailing address
5127 N NORDICA AVE, CHICAGO, IL 60656-3605
(773) 706-4540
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/12/2017
Last updated
06/10/2025
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