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General NPI Number Information
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NPI Number | 1649408683
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Entity Type | Organization
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Legal Business Name | MAKAI MOBILE REHAB, LLC
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 7114 NIUMALU LOOP
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City | HONOLULU
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State | HI
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Zip | 96825-1635
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Country | US
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Telephone | 808-783-9320
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Fax | 808-396-5581
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Provider Business Mailing Address
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Address Line | 7114 NIUMALU LOOP
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City | HONOLULU
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State | HI
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Zip | 96825-1635
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Country | US
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Telephone | 808-783-9320
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. JASON ALQUIZA DACUMOS
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Credential | PT, MPT, OCS
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Telephone | 808-783-9320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2561
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License Number State | HI
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