Provider Demographics
NPI:1003436312
Name:SHIMODA, ABE (DPT)
Entity Type:Individual
Prefix:
First Name:ABE
Middle Name:
Last Name:SHIMODA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7192 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1800
Mailing Address - Country:US
Mailing Address - Phone:808-396-7303
Mailing Address - Fax:808-395-7160
Practice Address - Street 1:7192 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1800
Practice Address - Country:US
Practice Address - Phone:808-396-7303
Practice Address - Fax:808-395-7160
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT2329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist