Provider Demographics
NPI:1215000807
Name:QUILLOY, BARRY RK (DPT)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:RK
Last Name:QUILLOY
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 1:850 W HIND DR
Mailing Address - Street 2:SUITE 104 AND 108
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1855
Mailing Address - Country:US
Mailing Address - Phone:808-373-4787
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR
Practice Address - Street 2:SUITE 104 AND 108
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1855
Practice Address - Country:US
Practice Address - Phone:808-373-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI6697487OtherUNIVERSITY HEALTH ALLIANC
HI00A0238368OtherHMSA QUEST PROV. NUMBER
HI209865OtherSUMMERLIN LIFE
HI00A0238368OtherHMSA PROV. NUMBER
HI55184701Medicaid
HI6697487OtherUNIVERSITY HEALTH ALLIANC