Provider Demographics
NPI:1992997266
Name:MARESCA, MICHAEL K (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:MARESCA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2258 PALOLO AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3122
Mailing Address - Country:US
Mailing Address - Phone:808-284-0824
Mailing Address - Fax:808-739-0824
Practice Address - Street 1:500 ALA MOANA BLVD
Practice Address - Street 2:SUITE 1-302
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4920
Practice Address - Country:US
Practice Address - Phone:808-284-0824
Practice Address - Fax:808-739-0824
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT - 1588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist