Healthcare Provider Details

I. General information

NPI: 1457391781
Provider Name (Legal Business Name): ERIKA FABIAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 MAKAWAO AVE SUITE 102
PUKALANI HI
96768
US

IV. Provider business mailing address

2343 UMI PL
HAIKU HI
96708-5851
US

V. Phone/Fax

Practice location:
  • Phone: 808-572-2281
  • Fax: 808-573-5869
Mailing address:
  • Phone: 808-575-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2597
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: