Healthcare Provider Details

I. General information

NPI: 1811486848
Provider Name (Legal Business Name): HOLISTICARE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S KING ST STE 300
HONOLULU HI
96814-2066
US

IV. Provider business mailing address

400 KEAWE ST APT 416
HONOLULU HI
96813-5955
US

V. Phone/Fax

Practice location:
  • Phone: 808-348-6336
  • Fax: 808-744-8571
Mailing address:
  • Phone: 808-348-6336
  • Fax: 808-744-8571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3594
License Number StateHI

VIII. Authorized Official

Name: YINGWEI CHANG
Title or Position: OWNER
Credential: DPT
Phone: 808-348-6336