Healthcare Provider Details

I. General information

NPI: 1871126300
Provider Name (Legal Business Name): ALEXIS NICOLE DAMO DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 550
HONOLULU HI
96814-1880
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 550
HONOLULU HI
96814-1880
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-8947
  • Fax: 800-586-4356
Mailing address:
  • Phone: 808-381-8947
  • Fax: 800-586-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-5000
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: