Provider Demographics
NPI:1528594439
Name:ARCA, PHILIP RUDGE (DPT)
Entity Type:Individual
Prefix:
First Name:PHILIP RUDGE
Middle Name:
Last Name:ARCA
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 1:45-035 KANEOHE BAY DR STE A
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2417
Mailing Address - Country:US
Mailing Address - Phone:808-234-5353
Mailing Address - Fax:808-234-5858
Practice Address - Street 1:45-035 KANEOHE BAY DR STE A
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2417
Practice Address - Country:US
Practice Address - Phone:808-234-5353
Practice Address - Fax:808-234-5858
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist