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1750514584 NPI number — CRYSTAL KIYOMI OKAMOTO PT

NPI Number: 1750514584
Health Care Provider/Practitioner: CRYSTAL KIYOMI OKAMOTO PT

Information about “1750514584” NPI (CRYSTAL KIYOMI OKAMOTO PT) exists in 1750514584 in HTML format HTML  |  1750514584 in plain Text format TXT  |  1750514584 in PDF (Portable Document Format) PDF  |  1750514584 in an XML format XML  formats.

NPI Number : 1750514584 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750514584",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OKAMOTO",
    "FirstName": "CRYSTAL",
    "MiddleName": "KIYOMI",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2430B OKA ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KILAUEA",
    "MailingAddressStateName": "HI",
    "MailingAddressPostalCode": "96754-5332",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "808-469-6069",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2430B OKA ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KILAUEA",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96754-5332",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-469-6069",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/27/2009",
    "LastUpdateDate": "10/16/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "2012038588",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "2786",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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