Provider Demographics
NPI:1629235080
Name:KANESHIRO, AVIS S (PT)
Entity Type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:S
Last Name:KANESHIRO
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:PO BOX 3264
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96801-3264
Mailing Address - Country:US
Mailing Address - Phone:808-533-2275
Mailing Address - Fax:808-533-1275
Practice Address - Street 1:2228 LILIHA STREET
Practice Address - Street 2:STE 407
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1654
Practice Address - Country:US
Practice Address - Phone:808-255-1200
Practice Address - Fax:808-748-0110
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 810225100000X
HIPT810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBG546YOtherMEDICARE PTAN