Provider Demographics
NPI:1184440992
Name:CAYABAN DE VERO, THEA ANN (PT/PTA)
Entity type:Individual
Prefix:
First Name:THEA ANN
Middle Name:
Last Name:CAYABAN DE VERO
Suffix:
Gender:F
Credentials:PT/PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-333 MOKUOLA ST APT 308
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-6320
Mailing Address - Country:US
Mailing Address - Phone:808-636-3018
Mailing Address - Fax:
Practice Address - Street 1:POHAKEA ELEMENTARY SCHOOL
Practice Address - Street 2:91750 FORT WEAVER ROAD
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-689-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPTA-5822081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine