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General NPI Number Information
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NPI Number | 1316413800
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Entity Type | Organization
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Legal Business Name | INDEPENDENT PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 3255 LAMALOA PL
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City | HONOLULU
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State | HI
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Zip | 96816-2535
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Country | US
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Telephone | 808-343-1756
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Fax | 808-312-3460
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Provider Business Mailing Address
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Address Line | PO BOX 11564
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City | HONOLULU
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State | HI
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Zip | 96828-0564
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MATTHEW PISKURA
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Credential | PT
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Telephone | 808-343-1756
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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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