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General NPI Number Information
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NPI Number | 1639333180
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Entity Type | Organization
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Legal Business Name | HAWAII SPORTS AND BALANCE CENTER
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 3088A AUKELE ST
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City | LIHUE
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State | HI
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Zip | 96766-1464
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Country | US
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Telephone | 808-634-7055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 288
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City | LIHUE
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State | HI
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Zip | 96766-0288
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEYNARD ENRIQUEZ
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Credential |
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Telephone | 808-634-7055
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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 | 2583
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License Number State | HI
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