Individual
BRYAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
45-090 NAMOKU ST, KANEOHE, HI 96744-5305
(808) 247-6211
Mailing address
749 HAO ST, HONOLULU, HI 96821-1619
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-447
HI
Other
Enumeration date
06/14/2019
Last updated
06/14/2019
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