Healthcare Provider Details

I. General information

NPI: 1841071875
Provider Name (Legal Business Name): BLAYNE KENOA MORRIS-KATO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-849 LUMIAINA ST UNIT 101
WAIPAHU HI
96797-5677
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 550
HONOLULU HI
96814-1880
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-8947
  • Fax: 800-586-4356
Mailing address:
  • Phone: 808-381-8947
  • Fax: 800-586-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-5781
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: