Provider Demographics
NPI:1932532173
Name:STUMPF, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:STUMPF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 ULUNIU ST
Mailing Address - Street 2:STE 404
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2534
Mailing Address - Country:US
Mailing Address - Phone:808-262-1118
Mailing Address - Fax:
Practice Address - Street 1:354 ULUNIU ST
Practice Address - Street 2:SUITE 404
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2528
Practice Address - Country:US
Practice Address - Phone:808-262-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60384442225100000X
HIPT-4332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist