# FUKUMOTO PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902597669
- **Authorized official:** JORDAN FUKUMOTO DPT (PHYSICAL THERAPIST)
- **Authorized official phone:** (808) 223-0496

## Contact information

- **Practice address:** 94-1245 HALEULULAAU ST \# A2-52, WAIPAHU, HI 96797-6218
- **Practice address phone:** (808) 223-0496
- **Mailing address:** 94-1245 HALEULULAAU ST \# A2-52, WAIPAHU, HI 96797-6218

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 05/15/2023
- **Last updated:** 05/15/2023