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General NPI Number Information
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NPI Number | 1811092406
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Entity Type | Organization
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Legal Business Name | CLUB REHAB, INC.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 73-5590 KAUHOLA ST STE A
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City | KAILUA KONA
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State | HI
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Zip | 96740-2610
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Country | US
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Telephone | 808-329-7744
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Fax | 808-334-1608
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Provider Business Mailing Address
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Address Line | 73-5590 KAUHOLA ST STE A
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City | KAILUA KONA
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State | HI
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Zip | 96740-2610
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Country | US
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Telephone | 808-329-7744
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Fax | 808-334-1608
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Authorized Official
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Title or Position | PRESIDENT
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Name | GORDON THOMAS DONG
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Credential |
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Telephone | 808-329-7744
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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 |
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License Number State |
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