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General NPI Number Information
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NPI Number | 1417330846
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Entity Type | Organization
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Legal Business Name | HOOLA MALAMALAMA
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 44-116 KEAALAU PLACE
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City | KANEOHE
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State | HI
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Zip | 96744
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Country | US
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Telephone | 808-683-9770
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Fax | 808-212-9459
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Provider Business Mailing Address
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Address Line | PO BOX 235-107
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City | HONOLULU
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State | HI
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Zip | 96823
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Country | US
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Telephone | 808-683-9770
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Fax | 808-212-9459
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. STEPHANIE MARIE TRUDELL
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Credential | DPT
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Telephone | 808-683-9770
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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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