Provider Demographics
NPI:1518008333
Name:BACKINOFF, STEVEN HILLARY (RPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:HILLARY
Last Name:BACKINOFF
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-0890
Mailing Address - Country:US
Mailing Address - Phone:808-828-0416
Mailing Address - Fax:808-828-0717
Practice Address - Street 1:2207 IO'ELA STREET
Practice Address - Street 2:STE A
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754
Practice Address - Country:US
Practice Address - Phone:808-828-0416
Practice Address - Fax:808-828-0717
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 1305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07486501Medicaid
HI52144Medicare ID - Type UnspecifiedPHYSICAL THERAPY