Provider Demographics
NPI:1194852962
Name:TAKIGUCHI, GRANT H (PT)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:H
Last Name:TAKIGUCHI
Suffix:
Gender:M
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:91-2139 FORT WEAVER RD
Mailing Address - Street 2:STE 210
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3609
Mailing Address - Country:US
Mailing Address - Phone:808-689-9994
Mailing Address - Fax:808-689-9995
Practice Address - Street 1:91-2139 FORT WEAVER RD
Practice Address - Street 2:STE 210
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3609
Practice Address - Country:US
Practice Address - Phone:808-689-9994
Practice Address - Fax:808-689-9995
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2013-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI1315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist