Healthcare Provider Details

I. General information

NPI: 1679998462
Provider Name (Legal Business Name): KUPONO PHYSICAL THERAPY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 S KING ST
HONOLULU HI
96826-2219
US

IV. Provider business mailing address

3239 POINCIANA PL
HONOLULU HI
96816-3534
US

V. Phone/Fax

Practice location:
  • Phone: 808-521-8500
  • Fax: 808-521-8501
Mailing address:
  • Phone: 808-371-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2838
License Number StateHI

VIII. Authorized Official

Name: SHAWNA YEE
Title or Position: PRESIDENT
Credential: DPT
Phone: 808-371-0025