Provider Demographics
NPI:1225283542
Name:CHILDS, BRIANNE RAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:RAE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:PT, DPT
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 81
Mailing Address - Street 2:
Mailing Address - City:KUALAPUU
Mailing Address - State:HI
Mailing Address - Zip Code:96757-0081
Mailing Address - Country:US
Mailing Address - Phone:808-658-0801
Mailing Address - Fax:
Practice Address - Street 1:1762 ALAHULA STREET
Practice Address - Street 2:#81
Practice Address - City:KUALAPUU
Practice Address - State:HI
Practice Address - Zip Code:96757-0081
Practice Address - Country:US
Practice Address - Phone:808-658-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 2966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist