Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1439 | HI |
NPI | 1154457711 |
---|---|
Provider Name | Mrs. Mary Anne Hill |
First Address | Kaunakakai, HI 96748-0980 |
Second Address | Kaunakakai, HI 96748-0408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1439 | STATE LICENSE (01) | HI |
496994 | (05) | HI |