Provider Demographics
NPI:1629136916
Name:GURK, MICHAEL R (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:GURK
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 1:1325 S KIHEI ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8145
Mailing Address - Country:US
Mailing Address - Phone:808-874-6972
Mailing Address - Fax:808-874-6973
Practice Address - Street 1:1325 S KIHEI ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8145
Practice Address - Country:US
Practice Address - Phone:808-874-6972
Practice Address - Fax:808-874-6973
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11617225100000X
HIPT4098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT116170Medicare ID - Type Unspecified