=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508598285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH ALEXIS BRUNSON DPT,PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2022
-----------------------------------------------------
Last Update Date | 07/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79-7422 MAMALAHOA HWY
-----------------------------------------------------
City | KEALAKEKUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96750-7913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-322-8400
-----------------------------------------------------
Fax | 808-322-5167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1469 GARLAND ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48214-3124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT-5409
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------