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General NPI Number Information
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NPI Number | 1326369364
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Entity Type | Organization
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Legal Business Name | RIDER PHYSICAL THERAPY & SPORTS CLINIC, INC.
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 5161 KUHIO HWY. SUITE E 202
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City | HANALEI
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State | HI
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Zip | 96714-0000
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Country | US
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Telephone | 808-826-7433
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Fax | 808-826-7437
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Provider Business Mailing Address
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Address Line | 4345 KUKE ST
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City | KILAUEA
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State | HI
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Zip | 96754-5310
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Country | US
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Telephone | 808-826-7433
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Fax | 808-826-7437
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JONATHAN RICHARD RIDER
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Credential | R.P.T.
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Telephone | 808-826-7433
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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 |
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License Number State |
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