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General NPI Number Information
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NPI Number | 1801245378
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Entity Type | Organization
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Legal Business Name | MAUI HOLISTIC PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 5281 LOWER KULA RD
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City | KULA
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State | HI
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Zip | 96790-7712
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Country | US
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Telephone | 808-269-2972
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Fax | 808-878-1879
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Provider Business Mailing Address
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Address Line | PO BOX 901559
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City | KULA
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State | HI
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Zip | 96790-1559
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Country | US
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Telephone | 808-269-2972
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Fax | 808-878-1879
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Authorized Official
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Title or Position | PHYSICAL THERAPIST AND OWNER
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Name | RAGNHILD A JENKINS
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Credential | PT
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Telephone | 808-269-2972
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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 | 3855
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License Number State | HI
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