Basic Information
| Provider Information | |||||||||
| NPI: | 1487692091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TURNER | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | JILL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAASKE | ||||||||
| OtherFirstName: | MARISSA | ||||||||
| OtherMiddleName: | JILL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1401 S BERETANIA ST | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968141870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085912244 | ||||||||
| FaxNumber: | 8085912245 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 S BERETANIA ST | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968141870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085912244 | ||||||||
| FaxNumber: | 8085912245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT1945 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 990353213 | 01 | HI | HMAA | OTHER |