Provider Demographics
NPI:1336379874
Name:KVALE, JOHN JAY (DPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JAY
Last Name:KVALE
Suffix:
Gender:M
Credentials:DPT
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 207
Mailing Address - Street 2:
Mailing Address - City:ELEELE
Mailing Address - State:HI
Mailing Address - Zip Code:96705-0207
Mailing Address - Country:US
Mailing Address - Phone:808-335-5808
Mailing Address - Fax:808-335-5657
Practice Address - Street 1:4353 WAIALO ROAD
Practice Address - Street 2:11A
Practice Address - City:ELEELE
Practice Address - State:HI
Practice Address - Zip Code:96705-0207
Practice Address - Country:US
Practice Address - Phone:808-335-5808
Practice Address - Fax:808-335-5657
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0709-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist