Provider Demographics
NPI:1356727325
Name:NAKANO, THAISA Y (PT)
Entity type:Individual
Prefix:
First Name:THAISA
Middle Name:Y
Last Name:NAKANO
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 1:1401 S BERETANIA ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1870
Mailing Address - Country:US
Mailing Address - Phone:808-381-8947
Mailing Address - Fax:808-591-2245
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:SUITE 550
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-381-8947
Practice Address - Fax:808-591-2245
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-4125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI990353213OtherUHA