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General NPI Number Information
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NPI Number | 1578867925
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Entity Type | Organization
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Legal Business Name | KOKUA PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 122 LANAKILA PL
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City | KIHEI
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State | HI
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Zip | 96753-8931
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Country | US
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Telephone | 808-463-7055
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Fax |
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Provider Business Mailing Address
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Address Line | 122 LANAKILA PL
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City | KIHEI
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State | HI
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Zip | 96753-8931
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Country | US
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Telephone | 808-463-7055
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS KOWALICK
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Credential | MSPT
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Telephone | 808-463-7055
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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 | 2580
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License Number State | HI
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