Provider Demographics
NPI:1790227791
Name:KIKUCHI, TAKUYA (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:TAKUYA
Middle Name:
Last Name:KIKUCHI
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PROSPECT AVE E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2318
Mailing Address - Country:US
Mailing Address - Phone:216-687-5287
Mailing Address - Fax:
Practice Address - Street 1:2121 EUCLID AVE
Practice Address - Street 2:SB6
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115
Practice Address - Country:US
Practice Address - Phone:216-687-4806
Practice Address - Fax:216-687-9267
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0050792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer