Healthcare Provider Details

I. General information

NPI: 1720574171
Provider Name (Legal Business Name): STEPHANIE YAMAMOTO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 KAPAHULU AVE STE 401
HONOLULU HI
96816-1332
US

IV. Provider business mailing address

95-1021 KAILEWA ST
MILILANI HI
96789-4287
US

V. Phone/Fax

Practice location:
  • Phone: 808-739-1977
  • Fax:
Mailing address:
  • Phone: 808-387-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4045
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: