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General NPI Number Information
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NPI Number | 1316498504
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Entity Type | Organization
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Legal Business Name | TRUE CORE PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/22/2016
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Last Update Date | 10/22/2016
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Provider Practice Location Address
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Address Line | 540 W KUIAHA RD
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City | HAIKU
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State | HI
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Zip | 96708-5623
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Country | US
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Telephone | 808-269-7935
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Fax |
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Provider Business Mailing Address
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Address Line | 540 W KUIAHA RD
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City | HAIKU
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State | HI
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Zip | 96708-5623
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Country | US
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Telephone | 808-269-7935
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | LISA GREGOIRE
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Credential | DPT
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Telephone | 808-269-7935
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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 | 2958
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License Number State | HI
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