Provider Demographics
NPI:1659099547
Name:MORIHARA, KELSEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MORIHARA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-143 KUPUOHI PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1123
Mailing Address - Country:US
Mailing Address - Phone:808-389-1642
Mailing Address - Fax:
Practice Address - Street 1:600 KAPIOLANI BLVD STE 409
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5141
Practice Address - Country:US
Practice Address - Phone:808-525-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist