Healthcare Provider Details

I. General information

NPI: 1215361936
Provider Name (Legal Business Name): REBOUND HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 KAMOKILA BLVD #201
KAPOLEI HI
96707-2055
US

IV. Provider business mailing address

338 KAMOKILA BLVD #201
KAPOLEI HI
96707-2055
US

V. Phone/Fax

Practice location:
  • Phone: 808-674-9998
  • Fax: 808-674-9877
Mailing address:
  • Phone: 808-674-9998
  • Fax: 808-674-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENELYN P OKUMOTO
Title or Position: MEMBER/PHYSICAL THERAPIST
Credential:
Phone: 808-674-9998