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NPI Code Detail

MEDICARE: JUDY D PETRETEE PT

MEDICARE: JUDY D PETRETEE PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT2027HI

General Provider Information

NPI Number : 1710213657
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY D PETRETEE PT
Provider Business Mailing Address
First Line : 5722 KALANIANAOLE HWY
Second Line :
City : HONOLULU
State : HI
Zip : 96821
Country : US
Telephone Number : 808-373-3555
Fax Number : 808-373-3666
Provider Business Practice Location Address
First Line : 5722 KALANIANAOLE HWY
Second Line :
City : HONOLULU
State : HI
Zip : 96821-2388
Country : US
Telephone Number : 808-373-3555
Fax Number : 808-373-3666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2009
Last Update Date : 10/28/2009

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Directions to “ JUDY D PETRETEE PT” Practice Location

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