1629309331 NPI number — PAKOLEA LLC

Table of content: (NPI 1073094744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629309331 NPI number — PAKOLEA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAKOLEA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BIG ISLAND PHYSICAL THERPAY CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629309331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6783
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-935-5255
Provider Business Mailing Address Fax Number:
808-961-9044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 KILAUEA AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-935-5255
Provider Business Practice Location Address Fax Number:
808-961-9044
Provider Enumeration Date:
01/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WAIKI
Authorized Official First Name:
SHAUNA
Authorized Official Middle Name:
KAIULANI RUSSELL
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
808-935-5255

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT-3052 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X , with the licence number: PT-3052 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com