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General NPI Number Information
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NPI Number | 1275964751
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Entity Type | Organization
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Legal Business Name | ANGIE PETERS MPT LLC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 135 S WAKEA AVE UNIT 112
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City | KAHULUI
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State | HI
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Zip | 96732-1385
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Country | US
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Telephone | 808-280-7711
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Fax | 808-442-0690
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Provider Business Mailing Address
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Address Line | PO BOX 790826
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City | PAIA
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State | HI
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Zip | 96779-0826
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Country | US
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Telephone | 808-280-7711
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Fax | 808-249-8650
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. ANGELA MARIE PETERS
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Credential | MPT
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Telephone | 808-280-7711
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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 | 2575
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License Number State | HI
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