Provider Demographics
NPI:1114098399
Name:NAGATA, CRAIG B (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
Last Name:NAGATA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3801
Mailing Address - Country:US
Mailing Address - Phone:808-979-0700
Mailing Address - Fax:808-979-0707
Practice Address - Street 1:1600 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3801
Practice Address - Country:US
Practice Address - Phone:808-979-0700
Practice Address - Fax:808-979-0707
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HII19225OtherHMSA
HII19225OtherHMSA