Healthcare Provider Details

I. General information

NPI: 1689806515
Provider Name (Legal Business Name): MCCARTHY ORTHOPEDIC REHABILITATION AND SPORTS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 MILILANI ST STE 702A
HONOLULU HI
96813-2993
US

IV. Provider business mailing address

415 ULUNIU ST STE A
KAILUA HI
96734-2503
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-9363
  • Fax: 808-523-9418
Mailing address:
  • Phone: 808-262-8808
  • Fax: 808-263-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 1843
License Number StateHI

VIII. Authorized Official

Name: MICHAEL R MCCARTHY
Title or Position: OWNER
Credential: PT
Phone: 808-262-8808