Provider Demographics
NPI:1063966489
Name:LANOUE, MARY ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:LANOUE
Suffix:
Gender:F
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 1:5952 WILDCAT LN
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-5087
Mailing Address - Country:US
Mailing Address - Phone:352-682-4788
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 207
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-487-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT4236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist