Basic Information
| Provider Information | |||||||||
| NPI: | 1720574171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAMAMOTO | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95-1021 KAILEWA ST | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967894287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083870736 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1029 KAPAHULU AVE STE 401 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968161332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087391977 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2018 | ||||||||
| LastUpdateDate: | 07/09/2018 | ||||||||
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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 | 261QP2000X | 4045 | HI | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.