Provider Demographics
NPI:1457123937
Name:TOKUSHIMA, SPENCER (DPT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:TOKUSHIMA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 HAULANI ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8419
Mailing Address - Country:US
Mailing Address - Phone:619-947-1374
Mailing Address - Fax:
Practice Address - Street 1:40 KUPAOA ST # B-201
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-6215
Practice Address - Country:US
Practice Address - Phone:808-872-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist