Provider Demographics
NPI:1477713923
Name:SMITH, BRIAN ACKLEY (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ACKLEY
Last Name:SMITH
Suffix:
Gender:M
Credentials: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 487
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-0487
Mailing Address - Country:US
Mailing Address - Phone:808-934-7392
Mailing Address - Fax:808-935-6895
Practice Address - Street 1:333 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3013
Practice Address - Country:US
Practice Address - Phone:808-961-3505
Practice Address - Fax:808-961-6505
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 2367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist