Provider Demographics
NPI:1487975280
Name:TABA, REIKO JANICE (PT)
Entity type:Individual
Prefix:MS
First Name:REIKO
Middle Name:JANICE
Last Name:TABA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:REIKO
Other - Last Name:CHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1415 VICTORIA ST
Mailing Address - Street 2:APT. 214
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3650
Mailing Address - Country:US
Mailing Address - Phone:808-342-8567
Mailing Address - Fax:
Practice Address - Street 1:1415 VICTORIA ST
Practice Address - Street 2:APT. 214
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3650
Practice Address - Country:US
Practice Address - Phone:808-342-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist