Healthcare Provider Details

I. General information

NPI: 1134268246
Provider Name (Legal Business Name): NEIL KATSUMI SHIMABUKURO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N VINEYARD BLVD STE 151
HONOLULU HI
96817-3938
US

IV. Provider business mailing address

1735 ALA AMOAMO ST APT B
HONOLULU HI
96819-1771
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-8947
  • Fax:
Mailing address:
  • Phone: 808-485-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1941
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: