Healthcare Provider Details

I. General information

NPI: 1972678761
Provider Name (Legal Business Name): BARRON LYNN FACKLER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79-1019 HAUKAPILA ST KONA COMMUNITY HOSPITAL
KEALAKEKUA HI
96750-7920
US

IV. Provider business mailing address

PO BOX 76
KEALAKEKUA HI
96750-0076
US

V. Phone/Fax

Practice location:
  • Phone: 808-322-4475
  • Fax: 808-322-4539
Mailing address:
  • Phone: 808-328-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1736
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: