Provider Demographics
NPI:1679998462
Name:KUPONO PHYSICAL THERAPY SPECIALISTS
Entity type:Organization
Organization Name:KUPONO PHYSICAL THERAPY SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-371-0025
Mailing Address - Street 1:3239 POINCIANA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3534
Mailing Address - Country:US
Mailing Address - Phone:808-371-0025
Mailing Address - Fax:
Practice Address - Street 1:2038 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2219
Practice Address - Country:US
Practice Address - Phone:808-521-8500
Practice Address - Fax:808-521-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT2838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty