Healthcare Provider Details

I. General information

NPI: 1912640053
Provider Name (Legal Business Name): TROY HIRO KUIOKA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 04/17/2022
Certification Date: 04/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 MASSACHUSETTS AVE
LA MESA CA
91941-7638
US

IV. Provider business mailing address

10325 CAMINITO CUERVO UNIT 190
SAN DIEGO CA
92108-1809
US

V. Phone/Fax

Practice location:
  • Phone: 619-465-1313
  • Fax:
Mailing address:
  • Phone: 808-721-7538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: