Healthcare Provider Details

I. General information

NPI: 1710029012
Provider Name (Legal Business Name): PHYSICAL THERAPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 KAPIOLANI BLVD SUITE 104
HONOLULU HI
96813-5212
US

IV. Provider business mailing address

770 KAPIOLANI BLVD SUITE 104
HONOLULU HI
96813-5212
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-9446
  • Fax: 808-596-9160
Mailing address:
  • Phone: 808-596-9446
  • Fax: 808-596-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberW40062604-01
License Number StateHI

VIII. Authorized Official

Name: BRYAN T. LEE
Title or Position: CO-OWNER
Credential: D.P.T.
Phone: 808-596-9446