MEDICARE: DAVID J MOLS RPT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	PT-416	HI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H0000CBBCB	OTHER	HI	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1154760643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID J MOLS RPT INC

Provider Business Mailing Address
First Line	:	99-128 AIEA HEIGHTS DR STE 701
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3940
Country	:	US
Telephone Number	:	808-488-5665
Fax Number	:	808-486-6090

Provider Business Practice Location Address
First Line	:	99-128 AIEA HEIGHTS DR STE 701
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3940
Country	:	US
Telephone Number	:	808-488-5665
Fax Number	:	808-486-6090

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. DAVID J MOLS
Credential	:	RPT
Telephone Number	:	808-488-5665

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	06/18/2013

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