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General NPI Number Information
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NPI Number | 1316087315
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Entity Type | Organization
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Legal Business Name | PORTNER ORTHOPEDIC REHABILITATION INCORPORATED
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 45-1144 KAMEHAMEHA HWY STE 200
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City | KANEOHE
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State | HI
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Zip | 96744-3226
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Country | US
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Telephone | 808-247-9408
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Fax |
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Provider Business Mailing Address
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Address Line | 46-001 KAMEHAMEHA HWY STE 109
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City | KANEOHE
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State | HI
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Zip | 96744-3724
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Country | US
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Telephone | 808-247-7596
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | RENE NOELLE MANSANAS
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Credential |
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Telephone | 808-379-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD-4132
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License Number State | HI
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