MEDICARE: MARESCA PHYSICAL THERAPY LLC

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	225100000X	Physical Therapist	PT - 1588	HI

General Provider Information

NPI Number	:	1285730291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARESCA PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	2258 PALOLO AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-3122
Country	:	US
Telephone Number	:	808-284-0824
Fax Number	:	808-739-0824

Provider Business Practice Location Address
First Line	:	500 ALA MOANA BLVD
Second Line	:	SUITE 1-302
City	:	HONOLULU
State	:	HI
Zip	:	96813-4920
Country	:	US
Telephone Number	:	808-284-0824
Fax Number	:	808-739-0824

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL KUHIO MARESCA
Credential	:	MPT, CERT. MDT
Telephone Number	:	808-284-0824

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/25/2011

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