Provider Demographics
NPI:1104180165
Name:KITAGAWA, MARI A (DPT)
Entity Type:Individual
Prefix:MS
First Name:MARI
Middle Name:A
Last Name:KITAGAWA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1027 SHANGRILA ST.,
Mailing Address - Street 2:BLDG 1867
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2101
Mailing Address - Country:US
Mailing Address - Phone:808-674-9595
Mailing Address - Fax:808-674-9696
Practice Address - Street 1:98-1247 KAAHUMANU ST.
Practice Address - Street 2:#118
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701
Practice Address - Country:US
Practice Address - Phone:808-674-9595
Practice Address - Fax:808-674-9696
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-3483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIGROUP-H53533Medicare PIN