Healthcare Provider Details

I. General information

NPI: 1316311194
Provider Name (Legal Business Name): MARC ESPOSITO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2-2488 KAUMUALII HWY
KALAHEO HI
96741-8311
US

IV. Provider business mailing address

2-2488 KAUMUALII HWY
KALAHEO HI
96741-8311
US

V. Phone/Fax

Practice location:
  • Phone: 808-335-5808
  • Fax: 808-335-5657
Mailing address:
  • Phone: 808-335-5808
  • Fax: 808-335-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA - 255
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: