Provider Demographics
NPI:1649335381
Name:PANEBIANCO, AMBER M (MPT)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:M
Last Name:PANEBIANCO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791954
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-1954
Mailing Address - Country:US
Mailing Address - Phone:808-249-0471
Mailing Address - Fax:808-873-6510
Practice Address - Street 1:285 W KAAHUMANU AVE STE 205
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1623
Practice Address - Country:US
Practice Address - Phone:808-877-4663
Practice Address - Fax:808-873-6510
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH57238Medicare PIN