Provider Demographics
NPI:1013177245
Name:SACKS, ASHLEY M (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:SACKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:135 S WAKEA AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1385
Mailing Address - Country:US
Mailing Address - Phone:808-280-7711
Mailing Address - Fax:808-442-0690
Practice Address - Street 1:135 S WAKEA AVE STE 112
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1385
Practice Address - Country:US
Practice Address - Phone:808-280-7711
Practice Address - Fax:808-442-0690
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7009403-2401225100000X
HIPT-4798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist