Healthcare Provider Details

I. General information

NPI: 1326236977
Provider Name (Legal Business Name): DEBRA LYNNE MASAKO HORIUCHI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8220
  • Fax: 808-983-6752
Mailing address:
  • Phone: 808-983-8220
  • Fax: 808-983-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT2788
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: