Provider Demographics
NPI:1184992703
Name:HEACOCK-KANG, STEPHANIE (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:HEACOCK-KANG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-1144 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3244
Mailing Address - Country:US
Mailing Address - Phone:808-235-7999
Mailing Address - Fax:808-235-7992
Practice Address - Street 1:45-1144 KAMEHAMEHA HWY STE 305
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3226
Practice Address - Country:US
Practice Address - Phone:808-235-7999
Practice Address - Fax:808-235-7992
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OH012845225100000X
HI3444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist