Healthcare Provider Details

I. General information

NPI: 1538657366
Provider Name (Legal Business Name): AARON PAUL SEKULICH MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

IV. Provider business mailing address

1830 MAHANA ST
HONOLULU HI
96816-2997
US

V. Phone/Fax

Practice location:
  • Phone: 808-373-3555
  • Fax:
Mailing address:
  • Phone: 808-721-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1769
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1769
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: