MEDICARE: MR. GRANT H TAKIGUCHI PT

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	1315	HI

General Provider Information

NPI Number	:	1194852962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GRANT H TAKIGUCHI PT

Provider Business Mailing Address
First Line	:	91-2139 FORT WEAVER RD
Second Line	:	STE 210
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3609
Country	:	US
Telephone Number	:	808-689-9994
Fax Number	:	808-689-9995

Provider Business Practice Location Address
First Line	:	91-2139 FORT WEAVER RD
Second Line	:	STE 210
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3609
Country	:	US
Telephone Number	:	808-689-9994
Fax Number	:	808-689-9995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/17/2013

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