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General NPI Number Information
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NPI Number | 1821259425
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Entity Type | Organization
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Legal Business Name | GDO INC.
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 91-1171 MAKAALOA ST
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City | EWA BEACH
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State | HI
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Zip | 96706-3929
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Country | US
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Telephone | 808-258-2125
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Fax |
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Provider Business Mailing Address
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Address Line | 91-1171 MAKAALOA ST
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City | EWA BEACH
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State | HI
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Zip | 96706-3929
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Country | US
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Telephone | 808-258-2125
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/PRESIDENT
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Name | MR. GARRETT WAKATO OKUBO
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Credential | M.S.P.T.
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Telephone | 808-258-2125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1339
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License Number State | HI
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