1053768127 NPI number — HAWAII PELVIC THERAPY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053768127 NPI number — HAWAII PELVIC THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII PELVIC THERAPY, 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:
Provider Other Organization Name Type Code:
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:
1053768127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 ULUKOU ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96734-4427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-990-9011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1188 BISHOP ST STE 910
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-990-9011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEBER
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
808-990-9011

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  8004 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 3328 , 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)