Provider Demographics
NPI:1902922909
Name:TRUMBLE, ELISE ALISON (PT)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:ALISON
Last Name:TRUMBLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1755
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-1755
Mailing Address - Country:US
Mailing Address - Phone:808-959-2944
Mailing Address - Fax:
Practice Address - Street 1:2980 AINAOLA DR
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3591
Practice Address - Country:US
Practice Address - Phone:808-959-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 1824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00B0217816OtherHMSA HALE ANUENUE
HIA217818OtherHMSA SOLE
HI00C0217814OtherHMSA LCC HILO
HIS88796Medicare UPIN
HI00B0217816OtherHMSA HALE ANUENUE