Provider Demographics
NPI:1215372792
Name:CORTES, SUSAN CAROL (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:CORTES
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 1:725 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE C124
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6012
Mailing Address - Country:US
Mailing Address - Phone:808-596-4650
Mailing Address - Fax:808-596-4651
Practice Address - Street 1:725 KAPIOLANI BLVD
Practice Address - Street 2:SUITE C124
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6012
Practice Address - Country:US
Practice Address - Phone:808-596-4650
Practice Address - Fax:808-596-4651
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist