Active NPI
Bradley A Fuller, P.T.
- Physical Therapist
- Honolulu, HI
National Provider Identifier
1871015644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 0617-01
- Practice address
- 1401 S Beretania St Ste 550
Honolulu, HI 96814-1880 - Phone
- (808) 591-2244
- Fax
- (808) 591-2245
- NPI assigned
- Jul 12, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0617-01 | HI | Primary |
Addresses
Primary practice location
1401 S Beretania St Ste 550
Honolulu, HI 96814-1880
Mailing address
1401 S Beretania St Ste 550
Honolulu, HI 96814-1880
Phone (808) 591-2244
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 99-0353213 | Other | HI | UHA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0617-01 | HI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1871015644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 S BERETANIA ST STE 550",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968141880",
"telephone_number": "808-591-2244",
"fax_number": "808-591-2245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 S BERETANIA ST STE 550",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968141880",
"telephone_number": "808-591-2244",
"fax_number": "808-591-2245"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "BRADLEY",
"middle_name": "A",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-12",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "HI",
"license": "0617-01",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHA",
"identifier": "99-0353213",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Honolulu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.