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General NPI Number Information
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NPI Number | 1073204749
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Entity Type | Organization
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Legal Business Name | ISLAND LIFE THERAPY AND WELLNESS SERVICES, LLC
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 68-1868 PUU NUI ST
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City | WAIKOLOA
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State | HI
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Zip | 96738-5232
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Country | US
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Telephone | 808-854-5746
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Fax |
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Provider Business Mailing Address
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Address Line | 68-1868 PUU NUI ST
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City | WAIKOLOA
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State | HI
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Zip | 96738-5232
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Country | US
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Telephone | 808-854-5746
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | KATELYN BRANCHFLOWER
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Credential | MOT, OTR
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Telephone | 818-518-4213
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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 |
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License Number State |
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