Provider Demographics
NPI:1770662793
Name:KASHIWABARA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:KASHIWABARA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:KASHIWABARA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-386-1716
Mailing Address - Street 1:2720 LOWREY AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1636
Mailing Address - Country:US
Mailing Address - Phone:808-386-1716
Mailing Address - Fax:808-591-9420
Practice Address - Street 1:98-1079 MOANALUA RD STE 610
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4716
Practice Address - Country:US
Practice Address - Phone:808-386-1716
Practice Address - Fax:808-591-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI539926Medicaid
HI539926Medicaid