Provider Demographics
NPI:1053927947
Name:MAGSANOC, JUSTIN N R (PT, DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:N R
Last Name:MAGSANOC
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1114 HANAKAHI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2241
Mailing Address - Country:US
Mailing Address - Phone:808-230-7561
Mailing Address - Fax:
Practice Address - Street 1:1001 KAMOKILA BLVD STE 114
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2095
Practice Address - Country:US
Practice Address - Phone:808-674-0500
Practice Address - Fax:808-674-0511
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist