MEDICARE: MR. JOSHUA YAHALOM DPT

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	PT292265	CA

General Provider Information

NPI Number	:	1386189397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSHUA YAHALOM DPT

Provider Business Mailing Address
First Line	:	465 KAWAILOA RD APT F
Second Line	:
City	:	KAILUA
State	:	HI
Zip	:	96734-3138
Country	:	US
Telephone Number	:	818-620-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1253 MAKALAPA GATE RD BLDG 1514
Second Line	:
City	:	JBPHH
State	:	HI
Zip	:	96860-4479
Country	:	US
Telephone Number	:	808-473-2444
Fax Number	:

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

Provider Enumeration Date	:	12/29/2016
Last Update Date	:	12/29/2016

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