Provider Demographics
NPI:1851672349
Name:NISHIMURA, LAUREL ANN KASAMOTO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:ANN KASAMOTO
Last Name:NISHIMURA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PUUHONU PL
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2001
Mailing Address - Country:US
Mailing Address - Phone:808-961-5776
Mailing Address - Fax:808-961-6473
Practice Address - Street 1:76 PUUHONU PL
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2001
Practice Address - Country:US
Practice Address - Phone:808-961-5776
Practice Address - Fax:808-961-6473
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist