Provider Demographics
NPI:1457439929
Name:KOMAI, CAROL L (MPT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:KOMAI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:CABALDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1001 KAMOKILA BLVD
Mailing Address - Street 2:SUITE 114 JCB
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2014
Mailing Address - Country:US
Mailing Address - Phone:808-674-9595
Mailing Address - Fax:808-674-9696
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:SUITE 114 JCB
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2014
Practice Address - Country:US
Practice Address - Phone:808-674-9595
Practice Address - Fax:808-674-9696
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50088601Medicaid
HI53673Medicare ID - Type Unspecified