Healthcare Provider Details

I. General information

NPI: 1033955737
Provider Name (Legal Business Name): JOSHUA RAYMOND HOSTETLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 MAUNALANI CIR
HONOLULU HI
96816-4019
US

IV. Provider business mailing address

1830 PALM AVE
PEARL CITY HI
96782-3775
US

V. Phone/Fax

Practice location:
  • Phone: 808-732-0771
  • Fax:
Mailing address:
  • Phone: 309-340-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number730
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: