Provider Demographics
NPI:1851578272
Name:MAHNS, LARISA M (PT)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:M
Last Name:MAHNS
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 1:1001 KAMOKILA BLVD
Mailing Address - Street 2:SUITE 111 JCB
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2014
Mailing Address - Country:US
Mailing Address - Phone:808-674-9595
Mailing Address - Fax:808-674-9696
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:SUITE 111 JCB
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:808-674-9696
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist