Healthcare Provider Details

I. General information

NPI: 1689879462
Provider Name (Legal Business Name): OHANA PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 CENTRAL AVE
WAILUKU HI
96793-1723
US

IV. Provider business mailing address

29 PUUKAI PL
KAHULUI HI
96732-3208
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-6878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT-703
License Number StateHI

VIII. Authorized Official

Name: ROSWITHA E GABRIEL
Title or Position: PRESIDENT
Credential:
Phone: 808-244-6878