Healthcare Provider Details

I. General information

NPI: 1932648284
Provider Name (Legal Business Name): KALO PHYSICAL THERAPY MULTISPECIALITY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5597 PALANI RD STE A1
KAILUA KONA HI
96740-1661
US

IV. Provider business mailing address

PO BOX 5235 APT J3
KAILUA KONA HI
96745-5235
US

V. Phone/Fax

Practice location:
  • Phone: 808-987-6795
  • Fax:
Mailing address:
  • Phone: 808-987-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT-3268
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-3268
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT-3268
License Number StateHI

VIII. Authorized Official

Name: DR. BRETT CAREY
Title or Position: CEO
Credential: DPT
Phone: 808-987-6795