Provider Demographics
NPI:1326362070
Name:MOMOHARA, BERT TSUNEO (PT)
Entity Type:Individual
Prefix:MR
First Name:BERT
Middle Name:TSUNEO
Last Name:MOMOHARA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 167C
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2656
Mailing Address - Country:US
Mailing Address - Phone:808-454-2285
Mailing Address - Fax:808-454-1334
Practice Address - Street 1:850 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 167C
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2656
Practice Address - Country:US
Practice Address - Phone:808-454-2285
Practice Address - Fax:808-454-1334
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist