=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821852880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PACIFIC THERAPY AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2024
-----------------------------------------------------
Last Update Date | 02/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 OHUKAI RD STE 103
-----------------------------------------------------
City | KIHEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96753-7058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-385-4867
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2607
-----------------------------------------------------
City | WAILUKU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96793-7607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-246-7937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JEFFREY SZOZDA II
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 586-246-7937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------