Healthcare Provider Details

I. General information

NPI: 1851824486
Provider Name (Legal Business Name): SHORELINE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66-150 KAMEHAMEHA HWY
HALEIWA HI
96712-1440
US

IV. Provider business mailing address

66-150 KAMEHAMEHA HWY
HALEIWA HI
96712-1440
US

V. Phone/Fax

Practice location:
  • Phone: 808-799-7137
  • Fax: 808-356-1084
Mailing address:
  • Phone: 808-799-7137
  • Fax: 808-356-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN D JONES
Title or Position: CO-OWNER
Credential: DPT
Phone: 239-440-1075