Provider Demographics
NPI:1710338207
Name:SAUPAN, TRENTON JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:JAMES
Last Name:SAUPAN
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 1:92-488 OHIO ST
Mailing Address - Street 2:KAPOLEI
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3404
Mailing Address - Country:US
Mailing Address - Phone:801-598-3446
Mailing Address - Fax:
Practice Address - Street 1:91-1027 SHANGRILA ST
Practice Address - Street 2:KAPOLEI
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2101
Practice Address - Country:US
Practice Address - Phone:808-674-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist