Basic Information
| Provider Information | |||||||||
| NPI: | 1033551478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLADO | ||||||||
| FirstName: | MAILE | ||||||||
| MiddleName: | MAE KAWANO | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 75424 | ||||||||
| Address2: | |||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967070424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086792686 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 302 CALIFORNIA AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WAHIAWA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967861841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086749595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2013 | ||||||||
| LastUpdateDate: | 12/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1484 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.