Provider Demographics
NPI:1275636581
Name:TADA, BERT CHIYOTANO (PT)
Entity Type:Individual
Prefix:MR
First Name:BERT
Middle Name:CHIYOTANO
Last Name:TADA
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 1:3465 WAIALAE AVENUE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-753-7617
Mailing Address - Fax:808-735-3556
Practice Address - Street 1:3465 WAIALAE AVENUE
Practice Address - Street 2:SUITE 240
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-753-7617
Practice Address - Fax:808-735-3556
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist