Healthcare Provider Details

I. General information

NPI: 1790860302
Provider Name (Legal Business Name): MICHAEL FERDUN PT, MS, GCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ULUKAHIKI ST
KAILUA HI
96734-4454
US

IV. Provider business mailing address

329 CALIFORNIA AVE #402
WAHIAWA HI
96786
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1805
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: