Provider Demographics
NPI:1093587834
Name:LOGUE, YVETTE VINCEE FARALA (PT)
Entity type:Individual
Prefix:
First Name:YVETTE VINCEE
Middle Name:FARALA
Last Name:LOGUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:YVETTE VINCEE
Other - Middle Name:ROBLES
Other - Last Name:FARALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1126 3RD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1448 KAMEHAMEHA IV RD APT C
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2561
Practice Address - Country:US
Practice Address - Phone:808-953-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist