MEDICARE: MS. ELIZABETH TANAKA PT, DPT, CERT. MDT

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	2251X0800X	Orthopedic Physical Therapist	2011	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9716603	OTHER	HI	UHA PIN#
2	208538	OTHER	HI	HEALTH MANAGEMENT NETWORK
3	00A0233534	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1295806347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH TANAKA PT, DPT, CERT. MDT

Provider Business Mailing Address
First Line	:	PO BOX 240794
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96824-0794
Country	:	US
Telephone Number	:	808-398-3357
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 ALOHEA AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-2206
Country	:	US
Telephone Number	:	808-398-3357
Fax Number	:

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	04/08/2015

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