Healthcare Provider Details

I. General information

NPI: 1295304384
Provider Name (Legal Business Name): MADE TO MOVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 AINALAKO RD
HILO HI
96720-3710
US

IV. Provider business mailing address

2148 AWAPUHI ST
HILO HI
96720-5290
US

V. Phone/Fax

Practice location:
  • Phone: 269-240-8855
  • Fax:
Mailing address:
  • Phone: 808-731-9827
  • Fax: 808-867-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE S WESTON
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: PHYSICAL THERAPIST
Phone: 808-731-9827