Healthcare Provider Details

I. General information

NPI: 1063321305
Provider Name (Legal Business Name): MICHAEL REYES
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 10TH AVE
HONOLULU HI
96816-3051
US

IV. Provider business mailing address

478 KUNEHI ST APT 103
KAPOLEI HI
96707-2088
US

V. Phone/Fax

Practice location:
  • Phone: 808-206-0808
  • Fax:
Mailing address:
  • Phone: 808-206-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-3679
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: