Provider Demographics
NPI:1255465647
Name:WISKE, JAI L (PT)
Entity type:Individual
Prefix:
First Name:JAI
Middle Name:L
Last Name:WISKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:WEISKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 HUKU LII PL STE 101
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7062
Mailing Address - Country:US
Mailing Address - Phone:808-879-0077
Mailing Address - Fax:
Practice Address - Street 1:118 MAA ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3602
Practice Address - Country:US
Practice Address - Phone:808-244-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2025-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist