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General NPI Number Information
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NPI Number | 1629369244
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Entity Type | Organization
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Legal Business Name | KILOHANA PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 829 HAAWI ST
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City | WAILUKU
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State | HI
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Zip | 96793-8353
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Country | US
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Telephone | 808-446-6382
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Fax |
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Provider Business Mailing Address
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Address Line | 829 HAAWI ST
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City | WAILUKU
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State | HI
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Zip | 96793-8353
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Country | US
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Telephone | 808-446-6382
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | BRIDGET VELASCO
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Credential | PT
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Telephone | 808-446-6382
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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 | 1131
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License Number State | HI
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