NPIMap

Organization Active NPI

Ewa Beach Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Ewa Beach, HI
National Provider Identifier
1467580712
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
1315 Issued in HI
Legal business name
EWA BEACH PHYSICAL THERAPY LLC
Practice address
91-2139 Fort Weaver Rd
Ste 210
Ewa Beach, HI 96706-3609
Phone
(808) 689-9994
Fax
(808) 689-9995
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

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 1315 HI Primary

Addresses

Primary practice location

91-2139 Fort Weaver Rd
Ste 210
Ewa Beach, HI 96706-3609

Mailing address

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

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
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

Other organizations with this tax ID 1

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

Locations

91-1121 Keaunui Dr
Ste 203
Ewa Beach, HI 96706
Phone (808) 689-9994

85-910 Farrington Hwy
Ste 104
Waianae, HI 96792
Phone (808) 850-1892

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

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": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1467580712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91-2139 FORT WEAVER RD",
            "address_2": "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": "91-2139 FORT WEAVER RD",
            "address_2": "STE 210",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967063609",
            "telephone_number": "808-689-9994",
            "fax_number": "808-689-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EWA BEACH PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2013-07-17",
        "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": "HI",
            "license": "1315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 17, 2013; 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.