Individual
MS. KELLY ANN FUMIE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
850 W HIND DR, SUITE 104 AND 108, HONOLULU, HI 96821-1855
(808) 373-4787
Mailing address
850 W HIND DR, SUITE 104 AND 108, HONOLULU, HI 96821-1855
(808) 373-4787
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2475
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000255364
HMSA QUEST PROV. NUMBER
HI
01
—
2695487
UNIVERSITY HEALTH ALLIANC
HI
05
—
57436001
—
HI
Enumeration date
11/15/2006
Last updated
07/09/2007
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