Healthcare Provider Details

I. General information

NPI: 1982939807
Provider Name (Legal Business Name): THERAPEUTIC FUSION: PHYSICAL THERAPY AND WELLNESS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 OHUKAI RD SUITE 310
KIHEI HI
96753-7061
US

IV. Provider business mailing address

42 HONUHULA ST
KIHEI HI
96753-6086
US

V. Phone/Fax

Practice location:
  • Phone: 808-891-1188
  • Fax: 808-875-0775
Mailing address:
  • Phone: 808-891-1188
  • Fax: 808-875-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT-2017
License Number StateHI

VIII. Authorized Official

Name: MRS. HEATHER LEIGH ARDOIN
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 808-891-1188