=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760618854
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL RUFINO, RPT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2009
-----------------------------------------------------
Last Update Date | 06/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 AULIKE ST KAILUA PROFESSIONAL CENTER, SUITE 201
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-2739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-230-2359
-----------------------------------------------------
Fax | 808-230-2375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 HAMAKUA DR # 418
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-230-2359
-----------------------------------------------------
Fax | 808-230-2375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/SOLE PRACTICE
-----------------------------------------------------
Name | MR. MICHAEL RUFINO
-----------------------------------------------------
Credential | RPT
-----------------------------------------------------
Telephone | 808-230-2359
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1844 HI
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------