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General NPI Number Information
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NPI Number | 1164647418
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Entity Type | Organization
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Legal Business Name | KIHEI-WAILEA PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 84 CENTRAL AVE
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City | WAILUKU
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State | HI
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Zip | 96793-1725
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Country | US
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Telephone | 808-879-5591
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 508
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City | KIHEI
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State | HI
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Zip | 96753-0508
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Country | US
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Telephone | 808-879-5591
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA E SANDERS
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Credential | PT
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Telephone | 808-879-5591
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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 | 561
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License Number State | HI
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