Healthcare Provider Details

I. General information

NPI: 1790881738
Provider Name (Legal Business Name): NORTH SHORE PYSICAL THERAPY & SPORTS REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-565 KAMEHAMEHA HWY
KAHUKU HI
96731-2202
US

IV. Provider business mailing address

56-565 KAMEHAMEHA HWY
KAHUKU HI
96731-2202
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-9885
  • Fax: 808-293-1999
Mailing address:
  • Phone: 808-293-9885
  • Fax: 808-293-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 1401
License Number StateHI

VIII. Authorized Official

Name: ALFRED S LOSBANOS
Title or Position: PT
Credential: PT
Phone: 808-293-9885