Provider Demographics
NPI:1730858291
Name:HIRATA, NICOLE EMI (DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:EMI
Last Name:HIRATA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:EMI
Other - Last Name:MATSUNAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:950 PILIALO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-4625
Mailing Address - Country:US
Mailing Address - Phone:808-597-4208
Mailing Address - Fax:
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:#114
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2097
Practice Address - Country:US
Practice Address - Phone:808-674-0500
Practice Address - Fax:808-674-0511
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist