Provider Demographics
NPI:1184765281
Name:WADE, FABIENNE MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:FABIENNE
Middle Name:MARIE
Last Name:WADE
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 1:59-791 ALAPIO RD
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9514
Mailing Address - Country:US
Mailing Address - Phone:808-638-5087
Mailing Address - Fax:808-535-5556
Practice Address - Street 1:932 WARD AVE 6TH FLOOR SUITE 600
Practice Address - Street 2:MANAKAI O MALAMA
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-535-5555
Practice Address - Fax:808-535-5556
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00H0028103OtherHMSA
HI025244OtherALOHA CARE
142261OtherDEPT.OF LABOR WASH WC
WA142261OtherDEPT.OF LABOR WASH. WC
025244OtherALOHA CARE
HI02524418Medicaid
HIH56589Medicare PIN
HI02524418Medicaid