Basic Information
| Provider Information | |||||||||
| NPI: | 1104180165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KITAGAWA | ||||||||
| FirstName: | MARI | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91-1027 SHANGRILA ST., | ||||||||
| Address2: | BLDG 1867 | ||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086749595 | ||||||||
| FaxNumber: | 8086749696 | ||||||||
| Practice Location | |||||||||
| Address1: | 98-1247 KAAHUMANU ST. | ||||||||
| Address2: | #118 | ||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086749595 | ||||||||
| FaxNumber: | 8086749696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 06/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-3483 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.