Provider Demographics
NPI:1801995303
Name:OKAMURA, JULIE (MSPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:OKAMURA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 MOANIALA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2546
Mailing Address - Country:US
Mailing Address - Phone:808-377-0442
Mailing Address - Fax:808-373-7218
Practice Address - Street 1:758 MOANIALA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2546
Practice Address - Country:US
Practice Address - Phone:808-377-0442
Practice Address - Fax:808-373-7218
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI567448Medicaid
HIDG1902Medicare UPIN
HI567448Medicaid