Provider Demographics
NPI:1396253431
Name:OGAWA, JESSICA M (PT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:OGAWA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3221 WAIALAE AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5849
Mailing Address - Country:US
Mailing Address - Phone:808-734-0020
Mailing Address - Fax:808-732-0010
Practice Address - Street 1:3221 WAIALAE AVE STE 360
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5849
Practice Address - Country:US
Practice Address - Phone:808-734-0020
Practice Address - Fax:808-732-0010
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist