Provider Demographics
NPI:1689114662
Name:MORIMOTO, KENNETH KEN (DPT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:KEN
Last Name:MORIMOTO
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 1:200 N VINEYARD BLVD STE 151
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3938
Mailing Address - Country:US
Mailing Address - Phone:808-531-1122
Mailing Address - Fax:
Practice Address - Street 1:200 N VINEYARD BLVD STE 151
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3938
Practice Address - Country:US
Practice Address - Phone:808-531-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT2688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist