Provider Demographics
NPI:1851351225
Name:DEMSKE, JENNIFER A (DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:DEMSKE
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 1:95-720 LANIKUHANA AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2985
Mailing Address - Country:US
Mailing Address - Phone:808-623-6244
Mailing Address - Fax:808-623-6414
Practice Address - Street 1:95-720 LANIKUHANA AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2985
Practice Address - Country:US
Practice Address - Phone:808-623-6244
Practice Address - Fax:808-623-6414
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11361275OtherCAQH
VA11361275OtherCAQH#
VA194012OtherANTHEM