MEDICARE: WALK & ROLL PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	2251N0400X	Neurology Physical Therapist

General Provider Information

NPI Number	:	1083461347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALK & ROLL PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	2855 E MANOA RD STE 105
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-1854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	96-1173 WAIHONA ST
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-1935
Country	:	US
Telephone Number	:	808-208-3555
Fax Number	:

Authorized Official
Title or Position	:	MEMBER-MANAGER
Name	:	DEVIN OTAGAKI
Credential	:	DPT
Telephone Number	:	808-292-1347

Provider Enumeration Date	:	05/03/2024
Last Update Date	:	07/01/2024

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Directions to “WALK & ROLL PHYSICAL THERAPY LLC ” Practice Location

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