Provider Demographics
NPI:1457689994
Name:ROBERTS, KATHLEEN B (MPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:380 HUKU LII PL
Mailing Address - Street 2:STE 105
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7043
Mailing Address - Country:US
Mailing Address - Phone:808-879-0077
Mailing Address - Fax:808-879-0177
Practice Address - Street 1:4310 LOWER HONOAPIILANI RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-9246
Practice Address - Country:US
Practice Address - Phone:808-669-0078
Practice Address - Fax:808-669-0178
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist