Provider Demographics
NPI:1659504066
Name:OHASHI-MATSUMURA, ADRIENNE A (DPT)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:A
Last Name:OHASHI-MATSUMURA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:A
Other - Last Name:OHASHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:762 KANOELEHUA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-987-2133
Mailing Address - Fax:808-982-9737
Practice Address - Street 1:762 KANOELEHUA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-987-2133
Practice Address - Fax:808-982-9737
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT3117225100000X
HIPT-3117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist