Provider Demographics
NPI:1952558785
Name:SCELSI, ANDREA (MPT)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:SCELSI
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:PO BOX 1872
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-8872
Mailing Address - Country:US
Mailing Address - Phone:708-975-1834
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-691-4468
Practice Address - Fax:808-691-4032
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015123225100000X
HI3611225100000X, 2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist