1265056154 NPI number — MOLOKAI PHYSICAL THERAPY & REHABILITATION LLC

Table of content: (NPI 1265056154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265056154 NPI number — MOLOKAI PHYSICAL THERAPY & REHABILITATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOLOKAI PHYSICAL THERAPY & REHABILITATION 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:
1265056154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 398
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAUNAKAKAI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96748-0398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-862-6787
Provider Business Mailing Address Fax Number:
808-762-1318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 ALA MALAMA ST UNIT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAUNAKAKAI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-862-6787
Provider Business Practice Location Address Fax Number:
808-762-1318
Provider Enumeration Date:
06/05/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CORREA
Authorized Official First Name:
GENEVIEVE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PHYSICAL THERAPIST/OWNER
Authorized Official Telephone Number:
808-650-2339

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com