Healthcare Provider Details

I. General information

NPI: 1225170020
Provider Name (Legal Business Name): STACEY NOELLE CALVERT P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

932 WARD AVE 7TH FLOOR
HONOLULU HI
96814-2131
US

IV. Provider business mailing address

95-624 MAKAIMOIMO ST
MILILANI HI
96789-2921
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-8947
  • Fax:
Mailing address:
  • Phone: 808-625-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2051
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: