Healthcare Provider Details

I. General information

NPI: 1215857313
Provider Name (Legal Business Name): JOSMIN MANOG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-035 KANEOHE BAY DR
KANEOHE HI
96744-2417
US

IV. Provider business mailing address

91-1043 AUKAHI ST
KAPOLEI HI
96707-1997
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-809
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: