Healthcare Provider Details

I. General information

NPI: 1427214717
Provider Name (Legal Business Name): JESSICA R SILSBY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 B SEVENTH ST
LANAI CITY HI
96763
US

IV. Provider business mailing address

PO BOX 30180
HONOLULU HI
96820-0180
US

V. Phone/Fax

Practice location:
  • Phone: 808-565-6423
  • Fax:
Mailing address:
  • Phone: 808-522-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number030955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: