Provider Demographics
NPI:1134248289
Name:MERRILL, LYNETTE DOMINGA ALEJO (PT)
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:DOMINGA ALEJO
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LYNETTE
Other - Middle Name:DOMINGA
Other - Last Name:ALEJO MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:91-105 FORT WEAVER RD
Mailing Address - Street 2:HOUSE C
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2957
Mailing Address - Country:US
Mailing Address - Phone:808-256-4368
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-983-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-2254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist