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General NPI Number Information
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NPI Number | 1184440992
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Entity Type | Individual
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Provider Name | THEA ANN CAYABAN DE VERO PT/PTA
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Gender | Female
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | POHAKEA ELEMENTARY SCHOOL 91750 FORT WEAVER ROAD
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City | EWA BEACH
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State | HI
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Zip | 96706
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Country | US
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Telephone | 808-689-1290
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Fax |
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Provider Business Mailing Address
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Address Line | 94-333 MOKUOLA ST APT 308
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City | WAIPAHU
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State | HI
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Zip | 96797-6320
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Country | US
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Telephone | 808-636-3018
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number | PTA-582
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License Number State | HI
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