Provider Demographics
NPI:1659869709
Name:TEAL, KATHRYN M (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:TEAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST STE 550
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1880
Mailing Address - Country:US
Mailing Address - Phone:808-591-2244
Mailing Address - Fax:808-591-2245
Practice Address - Street 1:1401 S BERETANIA ST STE 550
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1880
Practice Address - Country:US
Practice Address - Phone:808-591-2244
Practice Address - Fax:808-591-2245
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-4559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI99-0353213OtherUHA