Healthcare Provider Details

I. General information

NPI: 1245832021
Provider Name (Legal Business Name): KEOLA MOBILE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3457 PAWAINA ST
HONOLULU HI
96822-1356
US

IV. Provider business mailing address

3457 PAWAINA ST
HONOLULU HI
96822-1356
US

V. Phone/Fax

Practice location:
  • Phone: 808-779-2744
  • Fax: 808-855-6804
Mailing address:
  • Phone: 808-779-2744
  • 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: DR. DANIEL UYEUNTEN
Title or Position: OWNER
Credential: DPT, MBA
Phone: 808-779-2744