Provider Demographics
NPI:1346287539
Name:TANAKA, KRISTIE HIROMI (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:HIROMI
Last Name:TANAKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 IWILEI RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5086
Mailing Address - Country:US
Mailing Address - Phone:808-550-4774
Mailing Address - Fax:
Practice Address - Street 1:650 IWILEI RD
Practice Address - Street 2:SUITE 265
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5086
Practice Address - Country:US
Practice Address - Phone:808-550-4774
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 2560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI3142555OtherUNIVERSITY HEALTH ALLIANC
HI3142555OtherUNIVERSITY HEALTH ALLIANC