Provider Demographics
NPI:1972678761
Name:FACKLER, BARRON LYNN (PT)
Entity Type:Individual
Prefix:MR
First Name:BARRON
Middle Name:LYNN
Last Name:FACKLER
Suffix:
Gender:M
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:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-0076
Mailing Address - Country:US
Mailing Address - Phone:808-328-8173
Mailing Address - Fax:
Practice Address - Street 1:79-1019 HAUKAPILA ST
Practice Address - Street 2:KONA COMMUNITY HOSPITAL
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7920
Practice Address - Country:US
Practice Address - Phone:808-322-4475
Practice Address - Fax:808-322-4539
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist