NPIMap

Organization Active NPI

Ewa Beach Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Ewa Beach, HI
National Provider Identifier
1124741467
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
EWA BEACH PHYSICAL THERAPY LLC
Doing business as
Westside Physical Therapy
Practice address
91-1121 Keaunui Dr Ste 203
Ewa Beach, HI 96706-6366
Phone
(808) 689-9994
Fax
(808) 689-9995
NPI assigned
Sep 21, 2022
Organization subpart
Yes
Parent organization
EWA BEACH PHYSICAL THERAPY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Grant H Takiguchi, PTNPI 1194852962
Title
Owner
Phone
(808) 689-9994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

91-1121 Keaunui Dr Ste 203
Ewa Beach, HI 96706-6366

Mailing address

91-2139 Fort Weaver Rd Ste 210
Ewa Beach, HI 96706-3609
Phone (808) 689-9994

Other identifiers 2

IdentifierTypeStateIssuer
024988OtherHIHMSA
768765MedicaidHI

Other names 1

  • Westside Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101229000908 HI Part B Supplier - Clinic/Group Practice 5294716668 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ewa Beach, HI; Waianae, HI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ewa Beach Phys Therapy LLC2 organizations share this tax ID, including this one
Part of
Ewa Beach Phys Therapy LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

91-2139 Fort Weaver Rd
Ste 210
Ewa Beach, HI 96706
Phone (808) 680-0558

91-896 Makule Rd
Ewa Beach, HI 96706
Phone (808) 689-9994

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1124741467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91-2139 FORT WEAVER RD STE 210",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967063609",
            "telephone_number": "808-689-9994",
            "fax_number": "808-689-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91-1121 KEAUNUI DR STE 203",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967066366",
            "telephone_number": "808-689-9994",
            "fax_number": "808-689-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EWA BEACH PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EWA BEACH PHYSICAL THERAPY LLC",
        "enumeration_date": "2022-09-21",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "TAKIGUCHI",
        "authorized_official_first_name": "GRANT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-689-9994",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA",
            "identifier": "024988",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "768765",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westside Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Westside Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ewa Beach, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.