Healthcare Provider Details

I. General information

NPI: 1093483489
Provider Name (Legal Business Name): EMILY A WITTKE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 ULUNIU ST
KAILUA HI
96734-2519
US

IV. Provider business mailing address

407 ULUNIU ST STE 301
KAILUA HI
96734-2537
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4321
  • Fax:
Mailing address:
  • Phone: 808-261-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-6003
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214575
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: