Provider Demographics
NPI:1972302404
Name:GRODZKA, MAYA LAURA (DPT)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:LAURA
Last Name:GRODZKA
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 RAILROAD AVE # A4
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7509
Mailing Address - Country:US
Mailing Address - Phone:808-339-7861
Mailing Address - Fax:
Practice Address - Street 1:69 RAILROAD AVE # A4
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7509
Practice Address - Country:US
Practice Address - Phone:808-339-7861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist