Healthcare Provider Details

I. General information

NPI: 1396253431
Provider Name (Legal Business Name): JESSICA M. OGAWA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 WAIALAE AVE STE 360
HONOLULU HI
96816-5849
US

IV. Provider business mailing address

3221 WAIALAE AVE STE 360
HONOLULU HI
96816-5849
US

V. Phone/Fax

Practice location:
  • Phone: 808-734-0020
  • Fax: 808-732-0010
Mailing address:
  • Phone: 808-734-0020
  • Fax: 808-732-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4065
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: