Provider Demographics
NPI:1265533319
Name:PACILIO, GREGG JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:JOSEPH
Last Name:PACILIO
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 1:3738 A OMAO RD
Mailing Address - Street 2:
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756
Mailing Address - Country:US
Mailing Address - Phone:808-346-5972
Mailing Address - Fax:
Practice Address - Street 1:4643 WAIMEA CANYAN DR
Practice Address - Street 2:WEST KAUAI MEDICAL CENTER
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796-0337
Practice Address - Country:US
Practice Address - Phone:808-338-9457
Practice Address - Fax:808-338-9420
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT2224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist