Individual
MARK A STACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1043 MAKAWAO AVE, SUITE 107, MAKAWAO, HI 96768-9465
(808) 572-7790
(808) 573-4721
Mailing address
1043 MAKAWAO AVE, SUITE 107, MAKAWAO, HI 96768-9465
(808) 572-7790
(808) 573-4721
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1242
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1866663
UHA
HI
01
—
194058
HMN
HI
05
—
24461708
—
HI
05
—
24461709
—
HI
Enumeration date
04/17/2006
Last updated
07/08/2007
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