Provider Demographics
NPI:1003004896
Name:KAILUA PHYSICAL THERAPY CLINIC, INC
Entity Type:Organization
Organization Name:KAILUA PHYSICAL THERAPY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:808-261-8931
Mailing Address - Street 1:155 HAMAKUA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2849
Mailing Address - Country:US
Mailing Address - Phone:808-261-8931
Mailing Address - Fax:808-261-0301
Practice Address - Street 1:155 HAMAKUA DR
Practice Address - Street 2:SUITE B
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2849
Practice Address - Country:US
Practice Address - Phone:808-261-8931
Practice Address - Fax:808-261-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHKPTOtherMEDICARE ID