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General NPI Number Information
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NPI Number | 1063604353
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Entity Type | Organization
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Legal Business Name | OAHU THERAPY CLINIC LLC
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 1314 S KING ST STE 319
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City | HONOLULU
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State | HI
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Zip | 96814-2004
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Country | US
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Telephone | 808-596-4656
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Fax | 808-596-4647
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Provider Business Mailing Address
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Address Line | 1314 S KING ST STE 319
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City | HONOLULU
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State | HI
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Zip | 96814-2004
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Country | US
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Telephone | 808-596-4656
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Fax | 808-596-4647
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Authorized Official
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Title or Position | OWNER/ PHYSICAL THERAPIST
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Name | MS. JANICE EMPERIO MAGDALENA
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Credential | PT
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Telephone | 808-596-4656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT2022
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License Number State | HI
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