Provider Demographics
NPI:1487417200
Name:TAKUSHI-RAMOS, MINNA (LMT)
Entity type:Individual
Prefix:
First Name:MINNA
Middle Name:
Last Name:TAKUSHI-RAMOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MINNA
Other - Middle Name:
Other - Last Name:TAKUSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1557 EGLIN WAY SW APT C
Mailing Address - Street 2:
Mailing Address - City:BOLLING AFB
Mailing Address - State:DC
Mailing Address - Zip Code:20032-7320
Mailing Address - Country:US
Mailing Address - Phone:253-334-0501
Mailing Address - Fax:
Practice Address - Street 1:1557 EGLIN WAY SW APT C
Practice Address - Street 2:
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20032-7320
Practice Address - Country:US
Practice Address - Phone:253-334-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT200001269225700000X
VA0019018779225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist