Healthcare Provider Details

I. General information

NPI: 1336741958
Provider Name (Legal Business Name): KIRSTEN CONWAY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN KRULL DPT

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

IV. Provider business mailing address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

V. Phone/Fax

Practice location:
  • Phone: 808-373-3555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-06237
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2019042377
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-4983
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: