Individual
TRAVIS-MITCHELL OTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3138 WAIALAE AVE APT 113, HONOLULU, HI 96816-1539
(808) 225-9830
Mailing address
3138 WAIALAE AVE APT 113, HONOLULU, HI 96816-1539
(808) 225-9830
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-669
HI
Other
Enumeration date
12/23/2022
Last updated
12/23/2022
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