Provider Demographics
NPI:1083961148
Name:ALEX, BRENDAN ROBERT (DPT)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:ROBERT
Last Name:ALEX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-165 HUALALAI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1742
Mailing Address - Country:US
Mailing Address - Phone:808-329-0591
Mailing Address - Fax:808-329-2066
Practice Address - Street 1:75-165 HUALALAI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1742
Practice Address - Country:US
Practice Address - Phone:808-329-0591
Practice Address - Fax:808-329-2066
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-3536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist