Healthcare Provider Details

I. General information

NPI: 1659282663
Provider Name (Legal Business Name): SUSAN CAROL GROTH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WAIAKAMILO RD STE 105
HONOLULU HI
96817-4950
US

IV. Provider business mailing address

2957 KALAKAUA AVE APT 504
HONOLULU HI
96815-4648
US

V. Phone/Fax

Practice location:
  • Phone: 808-532-6744
  • Fax:
Mailing address:
  • Phone: 808-532-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number733
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: