Healthcare Provider Details

I. General information

NPI: 1679647739
Provider Name (Legal Business Name): ANNA LIZA ABANIEL SAMPAYAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA LIZA LOPEZ PT

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PUUHINA ST
HILO HI
96720-2012
US

IV. Provider business mailing address

14 PUUHINA ST
HILO HI
96720-2012
US

V. Phone/Fax

Practice location:
  • Phone: 808-388-2690
  • Fax:
Mailing address:
  • Phone: 808-388-2690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3780
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number019555-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: