Healthcare Provider Details

I. General information

NPI: 1255465647
Provider Name (Legal Business Name): JAI L WISKE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFREY WEISKE

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/14/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MAA ST
KAHULUI HI
96732-3602
US

IV. Provider business mailing address

411 HUKU LII PL STE 101
KIHEI HI
96753-7062
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-0077
  • Fax:
Mailing address:
  • Phone: 808-879-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1563
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: