Provider Demographics
NPI:1619924214
Name:TAGAWA, ROBERT KEN V (MS PT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KEN
Last Name:TAGAWA
Suffix:V
Gender:M
Credentials:MS PT, CSCS
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 1742
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-7742
Mailing Address - Country:US
Mailing Address - Phone:808-782-3626
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST STE 707
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4339
Practice Address - Country:US
Practice Address - Phone:808-782-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist