Healthcare Provider Details

I. General information

NPI: 1700425725
Provider Name (Legal Business Name): BOUNDLESS BREATH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5281 LOWER KULA RD
KULA HI
96790-7712
US

IV. Provider business mailing address

5281 LOWER KULA RD
KULA HI
96790-7712
US

V. Phone/Fax

Practice location:
  • Phone: 727-458-5738
  • Fax:
Mailing address:
  • Phone: 727-458-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: HEAVEN MARCULIS
Title or Position: OWNER
Credential: OTR/L
Phone: 727-458-5738