Healthcare Provider Details

I. General information

NPI: 1730680208
Provider Name (Legal Business Name): JOSEPH USSERY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3-1866 KAUMUALII HWY
LIHUE HI
96766-8606
US

IV. Provider business mailing address

1602 COLLEGE DR
PINEVILLE LA
71360-5132
US

V. Phone/Fax

Practice location:
  • Phone: 808-333-3688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4465
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: