Healthcare Provider Details

I. General information

NPI: 1558666925
Provider Name (Legal Business Name): SHANE E HAMMAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 WARD AVE 7TH FLOOR
HONOLULU HI
96814-2131
US

IV. Provider business mailing address

1667 LUCERNE ST STE B
MINDEN NV
89423-4360
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-8947
  • Fax: 808-396-6358
Mailing address:
  • Phone: 808-381-8947
  • Fax: 808-396-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-3309
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: