Basic Information
| Provider Information | |||||||||
| NPI: | 1861934713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10327 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968160327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087391977 | ||||||||
| FaxNumber: | 8087391979 | ||||||||
| Practice Location | |||||||||
| Address1: | 1029 KAPAHULU AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968161332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087391977 | ||||||||
| FaxNumber: | 8087391979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2016 | ||||||||
| LastUpdateDate: | 06/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | SAKAGAWA | ||||||||
| AuthorizedOfficialFirstName: | GINN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8087391977 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2300 | HI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | HI | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT2300 | 01 | HI | LICENSE | OTHER |