Healthcare Provider Details

I. General information

NPI: 1407346794
Provider Name (Legal Business Name): SARAH GONTOSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KANANI RD
KIHEI HI
96753-6805
US

IV. Provider business mailing address

719 ALAE RD
KULA HI
96790-8961
US

V. Phone/Fax

Practice location:
  • Phone: 808-633-4480
  • Fax:
Mailing address:
  • Phone: 808-283-7968
  • Fax: 808-283-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2344
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: