Healthcare Provider Details

I. General information

NPI: 1285713354
Provider Name (Legal Business Name): THERAPEUTIC ASSOCIATES OF MAUI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HANA HWY SUITE 107
KAHULUI HI
96732-2300
US

IV. Provider business mailing address

111 HANA HWY SUITE 107
KAHULUI HI
96732-2300
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-8717
  • Fax: 808-877-8718
Mailing address:
  • Phone: 808-877-8717
  • Fax: 808-877-8718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN T MIZOGUCHI
Title or Position: MEMBER/MANAGER
Credential: OTR
Phone: 808-877-8717