Healthcare Provider Details

I. General information

NPI: 1558467159
Provider Name (Legal Business Name): KILAUEA REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 KILAUEA AVE
HILO HI
96720-3013
US

IV. Provider business mailing address

PO BOX 487
HILO HI
96721-0487
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-3505
  • Fax: 808-961-6505
Mailing address:
  • Phone: 808-961-3505
  • Fax: 808-935-6895

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: MR. ERIC M. TULMAN
Title or Position: PRESIDENT
Credential: R.P.T.
Phone: 808-961-0058