Provider Demographics
NPI:1326459363
Name:MERRITT, GUSSIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GUSSIE
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3-1866 KAUMUALII HWY # 400
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-8606
Mailing Address - Country:US
Mailing Address - Phone:808-823-9300
Mailing Address - Fax:
Practice Address - Street 1:3-1866 KAUMUALII HWY
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-8606
Practice Address - Country:US
Practice Address - Phone:808-823-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5564225100000X
TX1241398174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist