Provider Demographics
NPI:1497234546
Name:VITITOW, CHIEKO ANNE (PT)
Entity Type:Individual
Prefix:
First Name:CHIEKO
Middle Name:ANNE
Last Name:VITITOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56-363 HUEHU ST
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2007
Mailing Address - Country:US
Mailing Address - Phone:518-545-1401
Mailing Address - Fax:
Practice Address - Street 1:56-363 HUEHU ST
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2007
Practice Address - Country:US
Practice Address - Phone:518-545-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014592-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist