Healthcare Provider Details

I. General information

NPI: 1982843470
Provider Name (Legal Business Name): ERIC H KAWAGUCHI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 03/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-720 LANIKUHANA AVE 140
MILILANI HI
96789-2985
US

IV. Provider business mailing address

95-720 LANIKUHANA AVE 140
MILILANI HI
96789-2985
US

V. Phone/Fax

Practice location:
  • Phone: 808-623-6244
  • Fax: 808-623-6414
Mailing address:
  • Phone: 808-623-6244
  • Fax: 808-623-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT - 1950
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: