Provider Demographics
NPI:1881744225
Name:LEE, BRYAN T (DPT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:T
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:770 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5212
Mailing Address - Country:US
Mailing Address - Phone:808-596-9446
Mailing Address - Fax:808-596-9160
Practice Address - Street 1:770 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5212
Practice Address - Country:US
Practice Address - Phone:808-596-9446
Practice Address - Fax:808-596-9160
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI209006700OtherOWCP #
HI200684033OtherUHC MEDICARE COMPLETE
HI201621OtherHMA SUMMERLIN
HI49621702OtherALOHA CARE QUEST #
HI49621701Medicaid
HIJ0224970OtherHMSA BCBS#
HI00J0224970OtherHMSA QUEST #
HI3953566OtherUHA #
HI200684033OtherHMAA #
HIZ1654OtherMDX INSURANCE CO
HI49621702OtherALOHA CARE QUEST #
HI00J0224970OtherHMSA QUEST #