Provider Demographics
NPI:1750476156
Name:KOYANAGI, CARA S (PT)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:S
Last Name:KOYANAGI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 KAHEKA ST APT 2205
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2458
Mailing Address - Country:US
Mailing Address - Phone:808-432-2180
Mailing Address - Fax:
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2014
Practice Address - Country:US
Practice Address - Phone:808-674-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-2314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist