MEDICARE: VANIA M ITO DPT, MOT

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	225X00000X	Occupational Therapist	1055	HI
2	225100000X	Physical Therapist	3370	HI

General Provider Information

NPI Number	:	1730502543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANIA M ITO DPT, MOT

Provider Business Mailing Address
First Line	:	3757 KUMUKOA PL
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-1107
Country	:	US
Telephone Number	:	808-352-8645
Fax Number	:

Provider Business Practice Location Address
First Line	:	3757 KUMUKOA PL
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-1107
Country	:	US
Telephone Number	:	808-352-8645
Fax Number	:

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

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	01/22/2026

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