Healthcare Provider Details

I. General information

NPI: 1427562305
Provider Name (Legal Business Name): PEDIATRIC THERAPIES HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 HOOHANA ST STE F
KAHULUI HI
96732-3527
US

IV. Provider business mailing address

28 MANO DR
KULA HI
96790-8526
US

V. Phone/Fax

Practice location:
  • Phone: 808-446-2032
  • Fax:
Mailing address:
  • Phone: 808-446-2032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT-3395
License Number StateHI

VIII. Authorized Official

Name: AMY PETERSON
Title or Position: CEO
Credential: DPT
Phone: 808-446-2032