Healthcare Provider Details

I. General information

NPI: 1851683213
Provider Name (Legal Business Name): BRIGHTON REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 WAIANUENUE AVE
HILO HI
96720-2020
US

IV. Provider business mailing address

206 N 2100 W
SALT LAKE CITY UT
84116-4740
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-1500
  • Fax: 808-933-1835
Mailing address:
  • Phone: 801-532-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES RANDY KIRTON
Title or Position: OWNER
Credential:
Phone: 801-532-4120