1548502651 NPI number — MAUI NATURAL MEDICINE & PHYSICAL THERAPY LLC

Table of content: (NPI 1548502651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548502651 NPI number — MAUI NATURAL MEDICINE & PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAUI NATURAL MEDICINE & PHYSICAL 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:
1548502651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 S KIHEI RD
Provider Second Line Business Mailing Address:
STE O BOX 707
Provider Business Mailing Address City Name:
KIHEI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96753-5220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-891-1111
Provider Business Mailing Address Fax Number:
808-442-9938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 S KIHEI ROAD
Provider Second Line Business Practice Location Address:
STE 102C
Provider Business Practice Location Address City Name:
KIHEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96753-8145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-891-1111
Provider Business Practice Location Address Fax Number:
808-442-9938
Provider Enumeration Date:
03/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FRANGOS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
MEMBER MANAGER
Authorized Official Telephone Number:
808-891-1111

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  3218 , 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)





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