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General NPI Number Information
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NPI Number | 1568918431
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Entity Type | Organization
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Legal Business Name | BETTY FACKLER DBA SOUTH KONA PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 82-6066 MAMALAHOA HWY 7
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City | CAPTAIN COOK
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State | HI
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Zip | 96704-8204
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Country | US
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Telephone | 808-323-8123
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Fax | 808-323-8125
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Provider Business Mailing Address
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Address Line | 82-6066 MAMALAHOA HWY 7
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City | CAPTAIN COOK
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State | HI
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Zip | 96704-8204
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Country | US
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Telephone | 808-323-8123
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Fax | 808-323-8125
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Authorized Official
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Title or Position | BILLING MANANGER
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Name | MENDY LACEY
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Credential |
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Telephone | 808-322-6149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT-1737
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License Number State | HI
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