Healthcare Provider Details

I. General information

NPI: 1861934713
Provider Name (Legal Business Name): PACIFIC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 KAPAHULU AVE SUITE 401
HONOLULU HI
96816-1332
US

IV. Provider business mailing address

PO BOX 10327
HONOLULU HI
96816-0327
US

V. Phone/Fax

Practice location:
  • Phone: 808-739-1977
  • Fax: 808-739-1979
Mailing address:
  • Phone: 808-739-1977
  • Fax: 808-739-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2300
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateHI

VIII. Authorized Official

Name: GINN C SAKAGAWA
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: MPT
Phone: 808-739-1977