Provider Demographics
NPI:1619040748
Name:MELCHER, KIRSTEN JEGSEN (RPT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:JEGSEN
Last Name:MELCHER
Suffix:
Gender:F
Credentials:RPT
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:808-395-2084
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:808-395-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI100003331-02OtherUNIVERSITY HEALTH ALLIANC
HI04449401Medicaid
HIA4968-2OtherHMSA QUEST PROV. NUMBER
HIP00074485OtherRAILROAD MEDICARE
HIA4968-2OtherHMSA PROV. NUMBER
HIB003OtherTRICARE FOR LIFE
HIB003OtherTRICARE MANAGED CARE
HI54449Medicare ID - Type UnspecifiedMEDICARE PROV. NUMBER