Provider Demographics
NPI:1154457711
Name:HILL, MARY ANNE (MHS, PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:HILL
Suffix:
Gender:F
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0980
Mailing Address - Country:US
Mailing Address - Phone:808-553-5804
Mailing Address - Fax:808-553-3164
Practice Address - Street 1:280 HOMEOLU PLACE
Practice Address - Street 2:MOLOKAI GENERAL HOSPITAL
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-0408
Practice Address - Country:US
Practice Address - Phone:808-553-3148
Practice Address - Fax:808-553-3164
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14392251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI496994Medicaid
HI1439OtherSTATE LICENSE