Provider Demographics
NPI:1578892675
Name:TALLETT, MALIA PUA LOKELANI (PT)
Entity Type:Individual
Prefix:MS
First Name:MALIA
Middle Name:PUA LOKELANI
Last Name:TALLETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MALIA
Other - Middle Name:PUA LOKELANI
Other - Last Name:PRUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2064 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5233
Mailing Address - Country:US
Mailing Address - Phone:808-339-7478
Mailing Address - Fax:808-657-4980
Practice Address - Street 1:2064 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5233
Practice Address - Country:US
Practice Address - Phone:808-339-7478
Practice Address - Fax:808-657-4980
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT34397225100000X
CAPT34397225100000X
HI3170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist