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General NPI Number Information
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NPI Number | 1982071544
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Entity Type | Individual
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Provider Name | JENNIFER MARIE TAVARES-PASAG PT
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Gender | Female
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 2-2514 KAUMUALII HWY 211
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City | KALAHEO
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State | HI
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Zip | 96741-8303
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Country | US
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Telephone | 808-495-8668
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Fax | 808-495-8669
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Provider Business Mailing Address
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Address Line | 2-2514 KAUMUALII HWY 211
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City | KALAHEO
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State | HI
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Zip | 96741-8303
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Country | US
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Telephone | 808-495-8668
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Fax | 808-495-8669
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3128
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License Number State | HI
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