Provider Demographics
NPI:1528459641
Name:ELAM, MATTHEW (DPT, LMT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ELAM
Suffix:
Gender:M
Credentials:DPT, 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 701119
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96709-1119
Mailing Address - Country:US
Mailing Address - Phone:808-674-9595
Mailing Address - Fax:808-674-9696
Practice Address - Street 1:91-1027 SHANGRILA ST # 1867
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2101
Practice Address - Country:US
Practice Address - Phone:808-674-9595
Practice Address - Fax:808-674-9696
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-8685225700000X
HI6177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist