Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 393 | HI |
NPI | 1093361453 |
---|---|
Provider Name | Susanna Caldwell |
First Address | Honolulu, HI 96816-4400 |
Second Address | Honolulu, HI 96816-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |