Healthcare Provider Details

I. General information

NPI: 1679158398
Provider Name (Legal Business Name): MALIA LAUER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 KAPIA RD
HANA HI
96713
US

IV. Provider business mailing address

PO BOX 611
HANA HI
96713-0611
US

V. Phone/Fax

Practice location:
  • Phone: 808-781-7924
  • Fax:
Mailing address:
  • Phone: 808-781-7924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MADELEINE LAUER
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: DPT
Phone: 808-781-7924