Provider Demographics
NPI:1902821424
Name:TOWNSEND, KELLY (MSPT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 KEOLU DR
Mailing Address - Street 2:C7A
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-261-9792
Mailing Address - Fax:808-262-8600
Practice Address - Street 1:1020 KEOLU DR
Practice Address - Street 2:C7A
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3845
Practice Address - Country:US
Practice Address - Phone:808-261-9792
Practice Address - Fax:808-262-8600
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT1720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI24966605Medicaid
HI100031Medicare ID - Type UnspecifiedPT