Provider Demographics
NPI:1932625977
Name:MURAOKA, TRAVIS ISAMU
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ISAMU
Last Name:MURAOKA
Suffix:
Gender:M
Credentials:
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 STE 550
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1880
Mailing Address - Country:US
Mailing Address - Phone:808-381-8947
Mailing Address - Fax:800-586-4356
Practice Address - Street 1:1401 S BERETANIA ST STE 550
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1880
Practice Address - Country:US
Practice Address - Phone:808-381-8947
Practice Address - Fax:005-864-3568
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5301225100000X
WAPT60748598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist