Provider Demographics
NPI:1235204413
Name:HAWAII CENTER FOR AQUATIC REHABILITATION, INC.
Entity Type:Organization
Organization Name:HAWAII CENTER FOR AQUATIC REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:KA'APU
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-934-0599
Mailing Address - Street 1:190 KEAWE STREET
Mailing Address - Street 2:SUITE 13
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2849
Mailing Address - Country:US
Mailing Address - Phone:808-934-0599
Mailing Address - Fax:808-934-0500
Practice Address - Street 1:190 KEAWE ST
Practice Address - Street 2:SUITE 13
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2849
Practice Address - Country:US
Practice Address - Phone:808-934-0599
Practice Address - Fax:808-934-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT - 656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI101169Medicare ID - Type Unspecified
HIH101169Medicare PIN