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General NPI Number Information
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NPI Number | 1013124460
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Entity Type | Organization
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Legal Business Name | KAHANA PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 1063 LOWER MAIN ST STE C213
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City | WAILUKU
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State | HI
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Zip | 96793-2038
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Country | US
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Telephone | 808-243-7870
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Fax |
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Provider Business Mailing Address
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Address Line | 1063 LOWER MAIN ST STE C213
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City | WAILUKU
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State | HI
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Zip | 96793-2038
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Country | US
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Telephone | 808-243-7870
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KORRE LEIGH PIEPER
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Credential | PT
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Telephone | 808-243-7870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | W40889200
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License Number State | HI
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