Provider Demographics
NPI:1487371167
Name:TAKARA, SHELLEE N (DPT)
Entity type:Individual
Prefix:
First Name:SHELLEE
Middle Name:N
Last Name:TAKARA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-657 PAPALEALII ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-2755
Mailing Address - Country:US
Mailing Address - Phone:808-773-8811
Mailing Address - Fax:808-495-4418
Practice Address - Street 1:99-115 AIEA HEIGHTS DR STE 253
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3975
Practice Address - Country:US
Practice Address - Phone:808-773-8811
Practice Address - Fax:808-495-4418
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPT-5526OtherHAWAII STATE PHYSICAL THERAPY LICENSE