Provider Demographics
NPI:1164530176
Name:TAIRA-TOKUUKE, PATTI H (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:H
Last Name:TAIRA-TOKUUKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HUALALAI ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3820
Mailing Address - Country:US
Mailing Address - Phone:808-969-3811
Mailing Address - Fax:808-969-6630
Practice Address - Street 1:116 HUALALAI ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3820
Practice Address - Country:US
Practice Address - Phone:808-969-3811
Practice Address - Fax:808-969-6630
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55977Medicare ID - Type UnspecifiedPT