Provider Demographics
NPI:1053486027
Name:TOM, STEVEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:TOM
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-456-5888
Mailing Address - Fax:808-455-6936
Practice Address - Street 1:880 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2649
Practice Address - Country:US
Practice Address - Phone:808-456-5888
Practice Address - Fax:808-455-6936
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH52084Medicare PIN
HIS89355Medicare UPIN