Provider Demographics
NPI:1821179060
Name:LEDESMA, DARCY S (PT)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:S
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:
Other - Last Name:STABLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2395 S KIHEI RD
Mailing Address - Street 2:STE 206
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8635
Mailing Address - Country:US
Mailing Address - Phone:808-244-5541
Mailing Address - Fax:808-242-8485
Practice Address - Street 1:2395 S KIHEI RD
Practice Address - Street 2:STE 206
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8635
Practice Address - Country:US
Practice Address - Phone:808-873-8478
Practice Address - Fax:808-874-0501
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2199225100000X
HIPT-2199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52758307Medicaid
HI5278305Medicaid
HI52758307Medicaid
HI56120Medicare PIN
HI5278305Medicaid