Provider Demographics
NPI:1134268246
Name:SHIMABUKURO, NEIL KATSUMI (PT)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:KATSUMI
Last Name:SHIMABUKURO
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 1:1735 ALA AMOAMO ST
Mailing Address - Street 2:APT B
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1771
Mailing Address - Country:US
Mailing Address - Phone:808-485-8855
Mailing Address - Fax:
Practice Address - Street 1:200 N VINEYARD BLVD
Practice Address - Street 2:STE 151
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3938
Practice Address - Country:US
Practice Address - Phone:808-381-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-1941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00D0227191OtherHMSA