Healthcare Provider Details

I. General information

NPI: 1184021016
Provider Name (Legal Business Name): AKINAKA MIURA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 BISHOP ST 1110
HONOLULU HI
96813-2807
US

IV. Provider business mailing address

1132 BISHOP ST 1110
HONOLULU HI
96813-2807
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-7300
  • Fax:
Mailing address:
  • Phone: 808-596-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3905
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60471943
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: