Provider Demographics
NPI:1275729279
Name:NIKOLAISEN, COURTNEY (DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:NIKOLAISEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:HORWATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:500 ALA MOANA BLVD. MARESCA PHYSICAL THERAPY
Mailing Address - Street 2:BLDG 1 SUITE 300
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-548-0824
Mailing Address - Fax:808-441-0042
Practice Address - Street 1:500 ALA MOANA BLVD. MARESCA PHYSICAL THERAPY
Practice Address - Street 2:BLDG 1 SUITE 300
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:253-278-1297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00008903OtherLICENSE
WAG8854460Medicare PIN