Healthcare Provider Details

I. General information

NPI: 1578142527
Provider Name (Legal Business Name): SAVANNAH-RAE SHERRY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAVANNAH-RAE MOLINA DPT

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

IV. Provider business mailing address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

V. Phone/Fax

Practice location:
  • Phone: 808-358-1587
  • Fax: 808-373-3666
Mailing address:
  • Phone: 808-358-1587
  • Fax: 808-373-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1342493
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5674
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13724
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: