Provider Demographics
NPI:1194769174
Name:RAYMOND, TANYA L (PT, LMT)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:L
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:PT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 KAULUA PL
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-9719
Mailing Address - Country:US
Mailing Address - Phone:808-351-4322
Mailing Address - Fax:808-757-9391
Practice Address - Street 1:36 KAULUA PL
Practice Address - Street 2:
Practice Address - City:PAIA
Practice Address - State:HI
Practice Address - Zip Code:96779-9719
Practice Address - Country:US
Practice Address - Phone:808-351-4322
Practice Address - Fax:808-757-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI583225100000X
HIPT583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07058601Medicaid
HI00M0091779OtherHMSA
HIM09177-9OtherHMSA
HI00M0091779OtherHMSA
HIM09177-9OtherHMSA
HIH51361Medicare UPIN