Provider Demographics
NPI:1982617098
Name:GO, KURT CL (ATC, RD/LD, LMT)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:CL
Last Name:GO
Suffix:
Gender:M
Credentials:ATC, RD/LD, LMT
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 319
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0319
Mailing Address - Country:US
Mailing Address - Phone:808-336-1115
Mailing Address - Fax:
Practice Address - Street 1:305 ONIONI DR.
Practice Address - Street 2:KAWELA PLANTATION 1 - LOT 42
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-0319
Practice Address - Country:US
Practice Address - Phone:808-336-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 2255A2300X
HI12983225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist