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General NPI Number Information
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NPI Number | 1376959650
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Entity Type | Organization
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Legal Business Name | PHYSICAL & INDUSTRIAL REHABILITATION CLINIC OF OAHU LLC
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 2810 PAA ST BUILDING A
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City | HONOLULU
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State | HI
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Zip | 96819-4429
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Country | US
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Telephone | 808-524-5247
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Fax | 808-440-5251
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Provider Business Mailing Address
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Address Line | 1221 KAPIOLANI BLVD STE 820
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City | HONOLULU
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State | HI
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Zip | 96814-3503
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Country | US
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Telephone | 808-524-5247
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Fax | 808-440-5251
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Authorized Official
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Title or Position | OWNER
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Name | JOHN MIZOGUCHI
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Credential | OTR
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Telephone | 808-524-5247
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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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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT151
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License Number State | HI
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