Healthcare Provider Details

I. General information

NPI: 1861165268
Provider Name (Legal Business Name): MVP REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-820 MOANALUA RD UNIT I5-1
AIEA HI
96701-5200
US

IV. Provider business mailing address

98-820 MOANALUA RD UNIT I5-1
AIEA HI
96701-5200
US

V. Phone/Fax

Practice location:
  • Phone: 808-216-2789
  • Fax: 808-888-2903
Mailing address:
  • Phone: 808-216-2789
  • Fax: 808-888-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE YAMAUCHI
Title or Position: OFFICE ASSISTANT
Credential:
Phone: 808-371-2684