Provider Demographics
NPI:1730502543
Name:ITO, VANIA M (DPT, MOT)
Entity type:Individual
Prefix:
First Name:VANIA
Middle Name:M
Last Name:ITO
Suffix:
Gender:F
Credentials:DPT, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3558 WOODLAWN DR APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1494
Mailing Address - Country:US
Mailing Address - Phone:808-554-0611
Mailing Address - Fax:
Practice Address - Street 1:3558 WOODLAWN DR APT A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1494
Practice Address - Country:US
Practice Address - Phone:808-554-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3370225100000X
HI1055225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist