Healthcare Provider Details

I. General information

NPI: 1568517845
Provider Name (Legal Business Name): KATHRYN J AVERY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST SUITE 450
HONOLULU HI
96814-1870
US

IV. Provider business mailing address

45-167 KEANA RD
KANEOHE HI
96744-2317
US

V. Phone/Fax

Practice location:
  • Phone: 808-537-6688
  • Fax: 808-537-6689
Mailing address:
  • Phone: 808-255-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2133
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: