Provider Demographics
NPI:1962995472
Name:ANAGARAN, JOHANNA (PT)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:ANAGARAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:CLOOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3124 MANOA RD APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1298
Mailing Address - Country:US
Mailing Address - Phone:808-462-9585
Mailing Address - Fax:
Practice Address - Street 1:5722 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2388
Practice Address - Country:US
Practice Address - Phone:808-373-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT4521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPT4521OtherPT LICENSE