Provider Demographics
NPI:1871777383
Name:LIN, LEONA MEILINPANG (MPT)
Entity type:Individual
Prefix:MRS
First Name:LEONA
Middle Name:MEILINPANG
Last Name:LIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:LEONA
Other - Middle Name:MEI LIN
Other - Last Name:PANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:414 KUWILI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5362
Mailing Address - Country:US
Mailing Address - Phone:808-532-6740
Mailing Address - Fax:
Practice Address - Street 1:414 KUWILI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5362
Practice Address - Country:US
Practice Address - Phone:808-532-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT16152251P0200X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist