Healthcare Provider Details

I. General information

NPI: 1417766197
Provider Name (Legal Business Name): KULA LANI PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 OMAOPIO RD
KULA HI
96790-8865
US

IV. Provider business mailing address

PO BOX 1694
KAHULUI HI
96733-1694
US

V. Phone/Fax

Practice location:
  • Phone: 808-250-6723
  • Fax:
Mailing address:
  • Phone: 808-250-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN GIANLORENZO
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 808-250-6723