Provider Demographics
NPI:1437927191
Name:DELA PENA, CARL JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:CARL JOHN
Middle Name:
Last Name:DELA PENA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 FARRINGTON HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2028
Mailing Address - Country:US
Mailing Address - Phone:808-674-1142
Mailing Address - Fax:808-674-1143
Practice Address - Street 1:725 KAPIOLANI BLVD STE C103
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6027
Practice Address - Country:US
Practice Address - Phone:808-674-1142
Practice Address - Fax:808-674-1143
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist