Provider Demographics
NPI:1922053800
Name:BLAKE HARDY, HILLARY (PT)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:BLAKE HARDY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:A
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2531
Mailing Address - Country:US
Mailing Address - Phone:808-243-6515
Mailing Address - Fax:
Practice Address - Street 1:80 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2531
Practice Address - Country:US
Practice Address - Phone:808-243-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-1723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI58886601Medicaid
HI0000261875OtherHMSA BILLING NUMBER
HI0000261875OtherHMSA BILLING NUMBER