Individual
MICHAEL JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
430 KELE ST, STE 401, KAHULUI, HI 96732-3406
(808) 871-0900
(808) 871-9119
Mailing address
53 N. PUUNENE AVE, SUITE 104, KAHULUI, HI 96732
(808) 871-0900
(808) 871-9119
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
858
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05710007
—
HI
Enumeration date
10/24/2006
Last updated
04/24/2018
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