Provider Demographics
NPI:1093234759
Name:KE OLA KINO PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:KE OLA KINO PHYSICAL THERAPY, LLC
Other - Org Name:KE OLA KINO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALIA
Authorized Official - Middle Name:PUA LOKELANI
Authorized Official - Last Name:TALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-238-4199
Mailing Address - Street 1:2064 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5233
Mailing Address - Country:US
Mailing Address - Phone:808-238-4199
Mailing Address - Fax:
Practice Address - Street 1:2064 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5233
Practice Address - Country:US
Practice Address - Phone:808-238-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT3170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty