Provider Demographics
NPI:1790729606
Name:NITAKE, ALAN D (PT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:D
Last Name:NITAKE
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 1:28 KUINEHE PLACE
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768
Mailing Address - Country:US
Mailing Address - Phone:310-528-8240
Mailing Address - Fax:310-329-9586
Practice Address - Street 1:81 MAKAWAO AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768
Practice Address - Country:US
Practice Address - Phone:808-572-2281
Practice Address - Fax:808-573-5869
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6944261QP2000X
HIPT-3528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT6944Medicare PIN