Tyler Ishimoto, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

T-001086412 Issued in HI

Practice address

1043 Makawao Ave
Makawao, HI 96768-9465

Phone

(808) 572-7790

NPI assigned

Aug 14, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Physical Therapy and SportsGroup PAC ID 6709890429, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elite Physical Therapy and Sports

  • Physical Therapist
  • Makawao, HI
  • NPI 1235180811
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1548043672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 KAWEO PL",
            "city": "KULA",
            "state": "HI",
            "postal_code": "967907939",
            "telephone_number": "808-854-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043 MAKAWAO AVE",
            "city": "MAKAWAO",
            "state": "HI",
            "postal_code": "967689465",
            "telephone_number": "808-572-7790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHIMOTO",
        "first_name": "TYLER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "HI",
            "license": "T-001086412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Hornback
• Shelbi E. Hughes, D.C.
• Helmi Hunin, MAT
• Kristen Hunter, LMT
• Independent Life Solutions
• Anthea Iuorno, MA, LMFT
• Karl Flint Jacobs, PSYD
• Henry L Janpol, ED.D.
• Michelle Janssen
• JB Speech Therapy LLC

• Physical Therapist in Makawao, HI
• Providers in Makawao, HI by specialty
• Physical Therapist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.