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General NPI Number Information
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NPI Number | 1144348673
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Entity Type | Organization
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Legal Business Name | LEEWARD OAHU REHAB SERVICES, L.L.C.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 94-356 WAIPAHU DEPOT ST
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City | WAIPAHU
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State | HI
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Zip | 96797-3057
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Country | US
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Telephone | 808-671-5928
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Fax | 808-677-2720
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Provider Business Mailing Address
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Address Line | 94-356 WAIPAHU DEPOT ST
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City | WAIPAHU
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State | HI
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Zip | 96797-3057
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Country | US
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Telephone | 808-671-5928
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Fax | 808-677-2720
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. VI D FUENTES
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Credential | P.T.
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Telephone | 808-671-5928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT 2421
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License Number State | HI
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