Healthcare Provider Details

I. General information

NPI: 1215326509
Provider Name (Legal Business Name): HOLISTICARE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 KEAWE ST # 416
HONOLULU HI
96813-5199
US

IV. Provider business mailing address

400 KEAWE ST # 416
HONOLULU HI
96813-5199
US

V. Phone/Fax

Practice location:
  • Phone: 808-348-6336
  • Fax:
Mailing address:
  • Phone: 808-348-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. YING-WEI JASON CHANG
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 808-348-6336