Healthcare Provider Details

I. General information

NPI: 1043137987
Provider Name (Legal Business Name): FREDERICK GRANT MILLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DILLINGHAM BLVD STE 317
HONOLULU HI
96817-4551
US

IV. Provider business mailing address

1001 DILLINGHAM BLVD STE 317
HONOLULU HI
96817-4551
US

V. Phone/Fax

Practice location:
  • Phone: 808-207-8558
  • Fax:
Mailing address:
  • Phone: 808-207-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-787
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: