Provider Demographics
NPI:1851537567
Name:VELASCO, BRIDGET A (PT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:VELASCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:A
Other - Last Name:KAUMEHEIWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:111 HANA HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732
Mailing Address - Country:US
Mailing Address - Phone:808-446-6382
Mailing Address - Fax:
Practice Address - Street 1:111 HANA HWY
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2300
Practice Address - Country:US
Practice Address - Phone:808-446-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT1131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist