Provider Demographics
NPI:1275639221
Name:PACILIO, MICHELLE (MPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PACILIO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2-2488 KAUMUALII HWY
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-8311
Mailing Address - Country:US
Mailing Address - Phone:808-335-5808
Mailing Address - Fax:808-335-5657
Practice Address - Street 1:2-2488 KAUMUALII HWY
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8311
Practice Address - Country:US
Practice Address - Phone:808-335-5808
Practice Address - Fax:808-335-5657
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHIPT2283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0262079OtherHMSA
HI101950OtherMEDICARE