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General NPI Number Information
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NPI Number | 1972678761
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Entity Type | Individual
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Provider Name | BARRON LYNN FACKLER P.T.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 79-1019 HAUKAPILA ST KONA COMMUNITY HOSPITAL
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City | KEALAKEKUA
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State | HI
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Zip | 96750-7920
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Country | US
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Telephone | 808-322-4475
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Fax | 808-322-4539
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Provider Business Mailing Address
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Address Line | PO BOX 76
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City | KEALAKEKUA
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State | HI
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Zip | 96750-0076
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Country | US
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Telephone | 808-328-8173
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1736
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License Number State | HI
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