Healthcare Provider Details

I. General information

NPI: 1144320615
Provider Name (Legal Business Name): MILTON ORTHOPAEDIC & SPORTS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55-3435 AKONI PULE HWY #7
HAWI HI
96719-9671
US

IV. Provider business mailing address

54-396 UNION MILL RD UNIT 1179
KAPAAU HI
96755-3050
US

V. Phone/Fax

Practice location:
  • Phone: 808-796-3221
  • Fax:
Mailing address:
  • Phone: 808-796-3221
  • Fax:

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: DR. DOUGLAS M WHITE
Title or Position: PRESIDENT
Credential:
Phone: 808-796-3221