Healthcare Provider Details

I. General information

NPI: 1215005574
Provider Name (Legal Business Name): COREN B SEKULICH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 SOUTH KING STREET
HONOLULU HI
96813-3009
US

IV. Provider business mailing address

826 SOUTH KING STREET
HONOLULU HI
96813-3009
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-9043
  • Fax: 808-526-0673
Mailing address:
  • Phone: 808-523-9043
  • Fax: 808-526-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1783
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: