Provider Demographics
NPI:1053678474
Name:KUAPAHI, KEANE A K (PTA)
Entity Type:Individual
Prefix:MR
First Name:KEANE
Middle Name:A K
Last Name:KUAPAHI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-8011
Mailing Address - Country:US
Mailing Address - Phone:808-258-5449
Mailing Address - Fax:
Practice Address - Street 1:3850 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3701
Practice Address - Country:US
Practice Address - Phone:253-845-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP16000029289225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant