Provider Demographics
NPI:1720574171
Name:YAMAMOTO, STEPHANIE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:YAMAMOTO
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 1:95-1021 KAILEWA ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4287
Mailing Address - Country:US
Mailing Address - Phone:808-387-0736
Mailing Address - Fax:
Practice Address - Street 1:1029 KAPAHULU AVE STE 401
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1332
Practice Address - Country:US
Practice Address - Phone:808-739-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4045261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy