Provider Demographics
NPI:1942699541
Name:FUNDAKOWSKI, KATIE AKIKO (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:AKIKO
Last Name:FUNDAKOWSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:AKIKO
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 N ANGELENO AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3401
Mailing Address - Country:US
Mailing Address - Phone:808-345-6973
Mailing Address - Fax:
Practice Address - Street 1:1292 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1228
Practice Address - Country:US
Practice Address - Phone:808-334-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist