Healthcare Provider Details

I. General information

NPI: 1073645545
Provider Name (Legal Business Name): GARRETT WAKATO OKUBO M.S. P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1171 MAKAALOA ST
EWA BEACH HI
96706-3929
US

IV. Provider business mailing address

99-611 ALIA PL
AIEA HI
96701-3330
US

V. Phone/Fax

Practice location:
  • Phone: 808-258-2125
  • Fax: 808-488-9854
Mailing address:
  • Phone: 808-258-2125
  • Fax: 808-488-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1339
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: