Provider Demographics
NPI:1689894156
Name:STRONG, TODD LOGAN (PT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:LOGAN
Last Name:STRONG
Suffix:
Gender:M
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 1479
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-7479
Mailing Address - Country:US
Mailing Address - Phone:808-349-3689
Mailing Address - Fax:
Practice Address - Street 1:5220 ALIOMANU ROAD
Practice Address - Street 2:
Practice Address - City:ANAHOLA
Practice Address - State:HI
Practice Address - Zip Code:96703
Practice Address - Country:US
Practice Address - Phone:808-349-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102871Medicare PIN