Healthcare Provider Details

I. General information

NPI: 1508790494
Provider Name (Legal Business Name): ARLENE DATU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 GOV CARLOS G CAMACHO RD
TAMUNING GU
96913-3128
US

IV. Provider business mailing address

850 GOV CARLOS G CAMACHO RD
TAMUNING GU
96913-3128
US

V. Phone/Fax

Practice location:
  • Phone: 671-788-1722
  • Fax:
Mailing address:
  • Phone: 671-788-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT107
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: