Provider Demographics
NPI:1639303779
Name:SURETTE, ELYSE MARIE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:ELYSE
Middle Name:MARIE
Last Name:SURETTE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-1230 MAMALAHOA HWY STE E11
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7301
Mailing Address - Country:US
Mailing Address - Phone:808-885-7131
Mailing Address - Fax:808-885-5926
Practice Address - Street 1:65-1230 MAMALAHOA HWY STE E11
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7301
Practice Address - Country:US
Practice Address - Phone:808-885-7131
Practice Address - Fax:808-885-5926
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist