Individual
TYLER ISHIMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1043 MAKAWAO AVE, MAKAWAO, HI 96768-9465
(808) 572-7790
Mailing address
11 KAWEO PL, KULA, HI 96790-7939
(808) 854-4288
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
T-001086412
HI
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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