MEDICARE: MRS. KRISTEN R N VAIL MPT

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
1	225100000X	Physical Therapist	1916	HI

General Provider Information

NPI Number	:	1922249861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN R N VAIL MPT

Provider Business Mailing Address
First Line	:	PO BOX 2886
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-0886
Country	:	US
Telephone Number	:	808-685-8801
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-2139 FORT WEAVER RD
Second Line	:	STE 210
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3609
Country	:	US
Telephone Number	:	808-674-9262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	08/18/2016

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