Healthcare Provider Details

I. General information

NPI: 1134248289
Provider Name (Legal Business Name): LYNETTE DOMINGA ALEJO MERRILL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNETTE DOMINGA ALEJO MERRILL PT

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

91-105 FORT WEAVER RD HOUSE C
EWA BEACH HI
96706-2957
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8220
  • Fax:
Mailing address:
  • Phone: 808-256-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2254
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: