Healthcare Provider Details

I. General information

NPI: 1093960171
Provider Name (Legal Business Name): VENTURE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KANANI RD
KIHEI HI
96753-6805
US

IV. Provider business mailing address

101 KANANI RD
KIHEI HI
96753-6805
US

V. Phone/Fax

Practice location:
  • Phone: 808-633-4480
  • Fax: 808-465-8155
Mailing address:
  • Phone: 808-633-4480
  • Fax: 808-465-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANN ANDERSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 808-633-4480