Provider Demographics
NPI:1245255751
Name:HOLCOMB, AISHA BORNAS (PT)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:BORNAS
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AISHA
Other - Middle Name:LOWELLA
Other - Last Name:BORNAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4679 KOLOHALA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5223
Mailing Address - Country:US
Mailing Address - Phone:808-638-1855
Mailing Address - Fax:808-356-1954
Practice Address - Street 1:4679 KOLOHALA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5223
Practice Address - Country:US
Practice Address - Phone:808-638-1855
Practice Address - Fax:808-356-1954
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT3872225100000X
HIPT3062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN3647004Medicaid
TN3647004Medicaid
TN3647004Medicare PIN
TN0446652Medicaid
TN446652Medicare ID - Type Unspecified